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carbohydrates and its classification and application

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The document provides a comprehensive overview of carbohydrates, detailing their history, functions, classifications, dietary guidelines, digestion, absorption, metabolism, and significance in oral health. It highlights the relationship between carbohydrate intake and dental health, particularly focusing on sugars and their impact on dental caries. The conclusion emphasizes the need for a holistic approach to promote healthy nutrition and the importance of understanding carbohydrate effects on health throughout different life stages.

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CARBOHYDRATES DR LAKSHMI J 1ST YEAR MDS DEPARTMENT OF PUBLIC HEALTH DENTISTRY
CONTENTS  Introduction  History  Functions  Classification-monosaccharides Oligosaccharides Polysaccharides  Dietary guidelines  Digestion of carbohydrates  Absorption of carbohydrates  Metabolism  Carbohydrates and oral health  Nutritional programs in India  Public health significance  Clinical significance  Conclusion  Reference
HISTORY • In nutritional terms, the diet of prehistoric man and his ancestors was rich in proteins, moderately rich in fat and usually poor in carbohydrate. • Later with the knowledge of fire and evolution of farming the ancestral man began the consumption of tuberous roots and inner barks of trees , nuts and seeds
INTRODUCTION • Carbohydrates are the most abundant of all the organic compounds in nature. • Composed of carbon, hydrogen, and oxygen. • The word Carbohydrate means ‘hydrates of carbon’. • Defined as polyhydroxy-aldehydes or ketones or compounds which produce them on hydrolysis.
FUNCTIONS • They are the most abundant dietary source of energy for all organisms. (4 Cal/g) • Precursors for many organic compounds ( fat, amino acid) • Structural compound of many organism fibers(cellulose) plants exoskeleton insects cell wall microorganisms
• Carbohydrates as glycoprotein and glycolipids participate in the structure of cell membrane and cellular functions such as cell growth, adhesion and fertilization. • Serve as a storage form of energy (glycogen) to meet the immediate energy demands of the body
NUTRIENTS MICRONUTRIETS MACRONUTRIENTS VITAMINS PROTEINS FAT WATER CARBOHYDRATES MINERALS
CLASSIFICATION OF CARBOHYDRATES MONOSACCHARIDES (MONOSES OR GLYCOSES) OLIGOSACCHARIDES) MO NOS ACC HA RID ES OLI GOS ACC HA RID ES POL YSA CC HA RID ES Glucose ,Fructose,Galactose Maltose,Lactose,Sucrose HETERO Mucopolysaccharides, glycoproteins Agar and pectin HOMO Starch glycogen cellulose
MONOPOLYSACCHARIDES • Sweet to taste-simple sugar • Crystalline in structure • Soluble in water • Cn(H2O)n • Cannot be further hdrolysed • Exhibits sterioisomerism –same structure,different spacial arrangement
Based on functional group Aldose ketose Based On No: Of Carbon Atom Triose Tetrose Pentose Hexose Heptose Functional group- aldehyde Eg-glyceraldehyde glucose Functional group-keto group Eg- dihydroxyacetone fructose 3C glyceraldehyde 4C D-erythrose 5C D-Ribose D-Xylose 6C D-Glucose D-Fructos3e D-Galactose 7C Sedoheptulose
GLUCOSE • OCCURRENCE- As a constituent of a. Polysaccharides-starch,cellulose,glycogen b. Disaccharides-maltose,lactose,sucrose • BIOCHEMICAL IMPORTANCE a. Sugar fuel of life b. Excreted in urine in diabetes c. Structural unit of cellulose in plants
GALACTOSE • OCCURRENCE- As constituent of lactose-milk sugar • BIOCHEMICAL IMPORTANCE- a. Normally Converted Into Glucose b. Failure Will Lead To Galactosemia
FRUCTOSE • OCCURRENCE- a. Fruits and honey b. As A constituent of sucrose and inulin • BIOCHEMICAL IMPORTANCE a. Its phosphates are intermediate of glycolysis
OLIGOSACCHARIDES • Sweet To Taste • Crystalline Structure • Contains 2-10 monosaccharides which are liberated on hydrolysis Based On no;of Monosaccharides Disaccharides Tri Tetra Penta …………………………………Etc
DISACCHARIDES • Most common • Contains 2 monosaccharides • Held together by glycosidic bond TYPES REDUCING NON REDUCING Contains free aldehyde and keto group Eg- maltose lactose Doesn’t have free aldehyde and keto group Eg- sucrose trehalose
MALTOSE • α D-Glucose α D-Glucose α(1-4) Glycosidic bond • Reducing property and osazone formation- free aldehyde group on C1 of 2nd glucose • Maltose 2α DGlucose hydrolyzed by dilute acid/maltase
SUCROSE (non reducing ) • Cane sugar- produced by sugar cane and sugar beets • α-D glucose β D fructose Glycosidic bond (α1- β2) • No free aldehyde or keto group- no osazone formation • Important source of dietry carohydrate • Sweetening agent • Sucrose Glucose+Fructose Hydrolysed by Sucrace (intestinal enzyme)
LACTOSE(reducing) • Milk sugar –found in milk • β D galactose β D Glucose β(1-4) glycosidic bond • Reducing property and osazone formatiom- C1 carbon is free in glucose • Main source of nutrition in young mammels • Lactose Glucose + Galactose Hydrolysed by lactase (intestinal enzyme)
POLYSACCHARIDES • Consist of repeat units of monosaccharides or their derivatives,held together by glycosidic bond • Primary function – structural and storage of energy • Polysaccharides are linear and branched TYPES Homopolysaccharides Heteropolysaccharides
HOMOPOLYSACCHARIDES • On hydrolysis produce similar or single type of mmonosaccharides • eg  Glucans  Fructosans  Glycogen  Cellulose  Chitin
Starch • Carbohydrate resourse of plants- dietrysourse of higher animals including man • High content Cereals Roots Tubes Vegetables • Homopolymer of D- Glucose Alpha- Glycosidic bond Glucosan Glucan
2 polysachharides Water soluble amylopectin 80-85% Water soluble amylose 15-30% Linear unbranched chain Branched chain Starch Amylase act on alpha 1-4 glycosidic bond In saliva and pancreas Dextrins, Isomaltose maltose
Glycogen • Carbohydrate reserve in animals • Animal starch • High in Liver, muscles, Brain • Found in plants without chlorophyll Yeast , fungus • Structure Similar to amylopectin ( branch) • Glucose repeating unit • Alpha(1-4) glucose bond and alpha (1-6) glucose bond
CELLULOSE • Exclusively in plants • Abundant organic sub in plant kingdom • Absent in animal body • β D GLUCOSE β D glucose β(1-4) glycosidic bond Cannot be digested by mammels lack enzyme that cleave β (1-4) glycosidic bond- but contain fiber- decrease absorption of glucose and cholestrol from intestine Cellulose cellubiose+ β D glucose hydrolysis
HETEROPOLYSACCHARIDES • On hydrolysis yield mixture of monosaccharides • eg-  Mucopolysaccharides hyaluronic acid,chondroitin sulfate,Heparin,dermatan sulfate Agar and pectins Glycoproteins
MUCOPOLYSACCHIRIDES • Heteroglycans made of repeating units of sugar derivatives like amino sugar and uronic acid– GAG • Acid mucopolysacchrides- sulfate and carboxyl group – acidity • Monopolysacchrides + proteins – mucoproteins / mucoids/proteoglycans-95% carb & 5% protein • Essential compound of tissue structure
carbohydrates and its classification and application
AGAR AND PECTINS AGAR • sea weeds • Polymer-galactose sulfate and glucose • Serves as dietry fibers PECTINS • Apple and citrous fruits • Contain – galactouronate and rhamnose
GLYCOPROTEINS • Protein + carbohydrate –through covalent bond • Carbohydrate content varies from – 1% to 90%
DIETARY GUIDELINES • Carbohydrates are major sources of energy in all human diets. • They provide energy of 4 Kcal/g. • In India, 70-80% of total dietary calories are derived from carbohydrates present in plant foods such as cereals, millets and pulses.
carbohydrates and its classification and application
A healthy diet of carbohydrates should include: Energy intake (calories) should balance energy expenditure. Limiting intake of free sugars to less than 10% of total energy. At least 400 gm of fruit and vegetables must be included every day in diet(raw and fresh preferably)
BALANCED DIET? • A balanced diet is one which provides all the nutrients in required amounts and proper proportions. • It can easily be achieved through a blend of the four basic food groups. (fruits, legumes, whole grains and vegetables)
•The quantities of foods needed to meet the nutrient requirements vary with age, gender, physiological status and physical activity. • A balanced diet should provide around 50-60% of total calories from carbohydrates, preferably from complex carbohydrates, about 10-15% from proteins and 20-30% from both visible and invisible fat.
IMPORTANCE OF DIET DURING DIFFERENT STANGES OF LIFE
carbohydrates and its classification and application
carbohydrates and its classification and application
carbohydrates and its classification and application
GLYCAEMIC INDEX • It is defined by the area under the two-hour blood glucose response curve following the ingestion of a fixed portion of test carbohydrate as a proportion (%) of the AUC of the standard. • Some foods containing different fractions of soluble and insoluble fibres favour slow release of sugar into small intestine and its absorption into blood. • Used in management of diabetes and control of obesity
carbohydrates and its classification and application
DIGESTION PRINCIPLE DIETRY CARBOHYDRATES • Polysacchrides- starch and glycogen(major , on heating it gets hydrated and good for digestion) • Disacchrides-lactose and sucrose • Monosacchrides- glucose and fructose ( minor ) • Occours 1. Breifly in mouth 2. Largly in intestine
carbohydrates and its classification and application
ABSORPTION • Occurs in – DUODENUM and JEJUNUM(upper) • Glucose • Fructose • Galactose Absorption
Mechanism of action
GALACTOSE – similar to glucose PHLORIZIN – blocks Na dependent transport of glucose and galactose FRUCTOSE – • Facillited diffusion mediated by carriers • No energy and Na dependency • Inside the cell – frusctose glucose capillaries PENTOSE –simple diffusion
NON DIGESTABLE CARBOHYDRATES • Plant foods – high fibers- cannot be digested ( human enzyme and intestinal bacteria) • Fibers – chemically complex carbohydrate Eg –  cellulose  Hemicellulose  Pectin  Lignin  gums
METABOLISM • GLYCOLYSIS • CITRIC ACID CYCLE • GLUCONEOGENESIS
GLYCOLYSIS
CITRIC ACID CYCLE
GLUCONEOGENESIS
CONCLUSION • A holistic approach is needed to promote the concept of healthy nutrition in whole country and Multi-sectoral innovative approaches to involve all age groups, keeping in view cultural diversity in food habits and earning capacity is required to make people aware of importance of healthy nutrition. • The initiative should be taken right from childhood in schools, child care centers and families so that foundation stone of healthy eating habits is laid down in right age and can be propagated in future generations well. • Availability of nutritious foods at low cost should be ensured by policy making, mobilizing community and health education
REFERENCE • Hardy K, Brand-Miller J, Brown KD, Thomas MG, Copeland L. The importance of dietary carbohydrate in human evolution. The Quarterly review of biology. 2015 Sep;90(3):251-68. • • Yudkin J. Evolutionary and historical changes in dietary carbohydrates. The American journal of clinical nutrition. 1967 Feb 1;20(2):108-15. • • K Park, Textbook of Preventive and Social medicine, 23rd edition. • • U Satyanarayana. Text Book of Biochemistry. Elsevier Health Sciences, 2014. • Healthy diet. WHO. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed on 17th July 2016 155
CARBOHYDRATES PART 2 DR LAKSHMI J 1ST YEAR MDS DEPARTMENT OF PUBLIC HEALTH DENTISTRY
CONTENTS  Introduction  History  Functions  Classification-monosaccharides Oligosaccharides Polysaccharides  Dietary guidelines  Digestion of carbohydrates  Absorption of carbohydrates  Metabolism  Carbohydrates and oral health  Clinical significance  Conclusion  Reference
The Impact of Carbohydrate Quality on Dental Plaque pH •A study investigated the effect of different starchy foods varying in their glycemic index (GI) on acute changes in dental plaque pH. •Higher GI starchy foods (such as white bread) produced greater acute plaque pH decreases and larger overall postprandial glucose responses compared to lower GI starchy foods (like canned chickpeas). CARBOHYDRATE AND ORAL HEALTH
STEPHANS CURVE • The pH of dental plaque under resting conditions (i.e., when no food or drink has been consumed), is fairly constant. •The response after exposure of dental plaque to a fermentable carbohydrate is that pH decreases rapidly, reaching a minimum in approximately 5 to 20 minutes. •This is followed by a gradual recovery to its starting value, usually over 30 to 60 minutes.
DENTAL CARIES •Diet and nutrition may interfere with the balance of tooth demineralization and remineralization in several ways. •The diet provides sugars and other fermentable carbohydrates, which are metabolized to acids by plaque bacteria . •The resultant low pH favors the growth of the acidogenic and aciduric bacteria (mutans streptococci). •Sucrose facilitates the colonization of teeth by mutans streptococci and their outgrowth
SALIVA •Nutrition may affect both the anatomy and function of salivary glands . •Chronic malnutrition may reduce the secretion rate of saliva and the buffer capacity of stimulated saliva but not that of unstimulated saliva . •Malnutrition can adversely affect the volume, antibacterial properties, and physiochemical properties of saliva.
PERIODONTITIS •Periodontal disease is an inflammatory response to bacterial products in dental plaque; it is an oral infectious disease that affects the supporting structures of the teeth. •No substantive data support a relation between intake of dietary sugars and risk of or progression of periodontal disease.
CARBOHYDRATES AND DENTAL CARIES
•The sugars most commonly found in an average diet are sucrose, glucose, fructose, lactose, and maltose, from which some regard sucrose as the most cariogenic. •When assessing a patient’s diet, it is essential to differentiate between natural and added sugars. •Role of sucrose in etiology of caries is strong and is based on epidemiological studies and controlled human and animal studies
•Natural sugars do not play a significant role in developing dental caries and other non-communicable diseases. •This is probably due to their protective components (polyphenolic compounds, calcium, water, and fiber) and the hardness of some fruits and vegetables, which stimulates saliva production.
SUGAR INTRINSIC SUGAR Inside the cell Fresh fruits and vegitables NON MILK SUGARS Table sugar Honey Fruit juice MILK SUGARS lactose EXTRINSIC SUGAR Outside the cell
Food and beverages Plaque microflora Fermentation Organic acid production Demineralization of tooth structure(Ph-5.5) Caries
Caries inducing potential of individual food can be measured by 3 methods In vitro model Monitoring the plaque PH change Animal testing 1. Adhesiveness of food 2. Enamel demineralizatio n 3. Production of titratable acid 4. Artificial mouth here the acidogenicity is tested either by 1. Invivio 2. Invitro Invito testing
Sugar and dental caries : factors affecting- 1. Type of sugars 2. Consistency of sugars 3. Frequency of consumption of sugars 4. Concentration of sugars
Type of sugars • Commonly available sugars- glucose, sucrose ,fructose, galactose and lacctose • Newburn 1967- sucrose is the arch criminal of dental caries Animal experiments shows that The group with high sucrose- shows more dental caries Ability of sucrose to encourage extensive production of dextran production in plaque
Starchy Food • Dietary starches refer to a variety of food rich in starch (a polymeric carbohydrate), including bread, pasta, potatoes, potato products, rice, oats, breakfast cereals, and other grains. • Dietary starches are of low cariogenicity. • Experiments in animals have demonstrated that raw starch has a low cariogenic potential; however, cooked starch is between a third and a half as cariogenic as sucrose. • Furthermore, combining sucrose and starch is possibly more cariogenic than sugar.
The Adhesiveness of Sugar • The adhesiveness of food is directly related to its cariogenic potential. • If the form of sugar has a great tendency to adhere to dental surfaces, the risk of caries increases. • Adhesion – interproximal area and occlusal area • Tackiness- ability of food to get stuck when little amount of force is applied. Seen in B/L/P area
Frequency of Sugar Consumed • Sugar consumption positively correlates with the development of dental caries. • Enamel is demineralized every time sugar is consumed, defined as a demineralization attack, and the demineralization increases with the frequency of such episodes.
•Konig et al – )animal experiment )states that even when total amount of sugar taken is same in different group of rats, the group with increased frequency of consumption has more caries •Firestone et al – dental caries decrease when the length of meal is increased •Vipeholm study – 24 toffe group- consumed sweet between meal develeoped more caries than other group
Concentration of sugar • The amount of sugar consumed also influences the severity of dental caries. • As concentration increases - dental caries also increases • Studies- same frequency but different concentration of sugar then higher concentration – more dental caires • Tristan de cunha- DC increases as sugar increases • Wartime- sugar decreases- DC decreases
DIET AND DENTAL CARIES EVIDENCES OBSERVATIONAL STUDIES INTERVENTIONAL STUDIES ANIMAL EXPERIMENTS ENAMEL SLAB EXPERIMENT PLAQUE PH EXPERIMENTS INCUBATION
Study Name Vipeholm Study Year Conducted from 1945 to 1955 Location Vipeholm Institution for the Mentally Subnormal in Lund, Sweden Aim To investigate the effects of different forms and frequencies of sugar consumption on dental caries among institutionalized adults Method Participants were divided into different groups with varying levels of sugar intake and exposure frequency(7) Sugar was provided in various forms such as toffee, caramel, and sweets. Results Increased rates of dental caries were observed in groups with higher sugar consumption, especially those with frequent sugar exposure. Individuals who consumed sugar between meals had more severe tooth decay compared to those who consumed sugar with meals. Conclusion The study conclusively demonstrated the strong association between high sugar consumption and the development of dental caries. It highlighted the importance of sugar intake frequency, showing that consuming sugar between meals had a greater impact on tooth decay.
Study Name Turku Sugar Study Year Conducted from 1972 to 1974de Location Turku, Finland Aim To compare the cariogenicity of sucrose, fructose and xylitol Method 125 young adult 3 groups –sucrose,fructose and xylitol Results 1st year- caries in sucrose=fructose,xylitol no caries 2nd year-sucrose-caries increased Fructose-unchanged Xylitol-almost no caries Conclusion Fructose- less cariogenic than sucrose Xylitol - noncariogenic
Study Name Hopewood House Study Year Conducted from 1940s to 1950s Location Hopewood House, a vegetarian community in New South Wales, Australia Aim To investigate the effects of a vegetarian diet (low in refined sugars) on dental caries in children Method The study included children living at Hopewood House, a community following a strict vegetarian diet. The diet consisted mainly of whole grains, fruits, vegetables, and dairy, with minimal processed or refined sugars. Results Children at Hopewood House had significantly lower rates of dental caries compared to the general population. The prevalence and severity of dental caries were notably reduced in children following the vegetarian diet. The prevalence and severity of dental caries were notably reduced in children following the vegetarian diet. Conclusion The Hopewood House Study demonstrated the benefits of a vegetarian diet, low in refined sugars, for dental health. It highlighted the importance of whole foods and minimal processed
Study Title Hereditary Fructose Intolerance (HFI) Study Year Conducted from various years, ongoing research Location Multiple locations where HFI patients were studied Aim To investigate the dental health outcomes of individuals with Hereditary Fructose Intolerance (HFI) Method -The study involved individuals diagnosed with HFI, a genetic disorder affecting the ability to metabolize fructose properly. -HFI patients were monitored for dental caries incidence and severity over time. -Researchers compared the dental health of HFI patients to control groups without HFI. Results -Individuals with HFI were found to have a higher prevalence of dental caries compared to the control groups. -The severity of dental caries in HFI patients was notably higher, especially in those who consumed fructose-containing foods. -The study highlighted the importance of dietary management in HFI to prevent tooth decay. Conclusion -It emphasized the need for strict dietary management, including avoiding fructose- containing foods, to maintain oral health in HFI patients.
Study Name Tristan da Cunha Study Year Conducted from 1950s to 1960s Location Tristan da Cunha, a remote island in the South Atlantic Ocean Aim To investigate the dental health outcomes of a population with limited access to refined sugars and modern dental care Method -The study focused on the isolated population of Tristan da Cunha, who had minimal access to refined sugars -Dietary analysis was conducted to assess the types and quantities of foods consumed by the population. -Dental examinations were performed to evaluate the prevalence and severity of dental caries.. Results -The population of Tristan da Cunha had remarkably low rates of dental caries compared to more industrialized populations. -The prevalence and severity of dental caries were notably reduced, likely due to the absence of refined sugars in the diet. -The study highlighted the impact of a diet low in refined sugars and processed foods on dental health. -The Tristan da Cunha Study demonstrated the benefits of a diet low in refined sugars in preventing dental caries.
ANIMAL EXPERIMENTS • Aspects of diet –sugar content , frequency,content of diet other than sugar can be controlled • total experiment period is less • Rats, hamsters and monkeys are used • Disadvantage- difficulty in extrapolating the findings to humans
Enamel slab method • Observe the effect of diet in dental caries in slab of enamel which are held in mouth of humans in a removable plate constructed like a partial denture or orthodontic appliances • Then patient can be fed with the desired diet or the appliance can be taken out and place it in the desired solution.
Plaque PH experiments • Investigate the effect of food meals or components of food on the PH of dental plaque • Easy to do • Measure the acidogenicity instead of cariogenicity of diet
Incubation method • weakest and the simplest method • Test food are incubated with plaque or saliva and the rate of acid production is recorded  Rapid acid production- food is cariogenic  Slow acid production – little clinical significance • Disadvantage -The important aspect of dental caries (that is saliva )cannot be reproduced outside the mouth.
CLINICAL SIGNIFICANCE INCREASED LEVELS OF CARBOHYDRATE 1. Weight Gain: • One of the most immediate effects of excess carbohydrate consumption is weight gain. • Carbohydrates are a primary source of energy, and when they are consumed in excess of what the body needs for energy, they are converted into glycogen and stored in the liver and muscles. • However, once these glycogen stores are full, the excess carbohydrates are converted into fat and stored in adipose tissue, leading to weight gain.
2.Increased Blood Sugar Levels •Consuming too many carbohydrates, especially those with a high glycemic index (rapidly raising blood sugar), can cause spikes in blood sugar levels. •This can lead to a temporary energy boost followed by a crash, leaving one feeling fatigued, irritable, and hungry again shortly after eating.
3.Insulin Resistance • Excess carbohydrate intake over time can lead to insulin resistance. When the body consistently has high levels of blood sugar due to excessive carbohydrate consumption, the pancreas produces more insulin to help regulate blood sugar levels. •Over time, the cells become less responsive to insulin's signals, leading to insulin resistance, a precursor to type 2 diabetes.
4.Increased Risk of Type 2 Diabetes: • Prolonged excessive carbohydrate intake and subsequent insulin resistance can ultimately lead to the development of type 2 diabetes. •The body's inability to effectively regulate blood sugar levels can result in chronically elevated blood sugar, causing damage to blood vessels and organs.
5.High Triglycerides: •Diets high in simple carbohydrates (like sugar and refined grains) can lead to elevated triglyceride levels in the blood. • High triglycerides are a risk factor for heart disease. 6.Risk of Metabolic Syndrome • Metabolic syndrome is a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. • Excessive carbohydrate consumption, particularly of refined carbohydrates, is linked to an increased risk of developing metabolic syndrome.
7.Increased Risk of Cardiovascular Disease •Excessive carbohydrate consumption, especially when it leads to weight gain and high triglycerides, can increase the risk of cardiovascular disease. •This includes conditions such as heart attack, stroke, and atherosclerosis.
8.Gut Health Issues •Diets high in certain types of carbohydrates, particularly refined sugars, can negatively impact gut health by promoting the growth of harmful bacteria and reducing the population of beneficial bacteria. •This imbalance can lead to digestive issues, inflammation, and a weakened immune system.
Decreased levels of carbohydrates 1.Keto Flu •When transitioning to a very low-carb or ketogenic diet, some people may experience symptoms like headaches, fatigue, irritability, and dizziness. •This is often referred to as the "keto flu" and is temporary as the body adjusts to using ketones for energy.
2.Nutrient Deficiencies • Carbohydrates are a source of important nutrients like fiber, vitamins, and minerals. •Drastically reducing carbohydrate intake without careful planning can lead to deficiencies if these nutrients are not adequately replaced through other food sources or supplements. .
3.Reduced Athletic Performance •Carbohydrates are the body's preferred source of fuel for high-intensity exercise. •Athletes who engage in intense training may find their performance impacted by a low-carb diet, especially during sprinting or high-intensity workouts.
4.Digestive Issues • Some people may experience constipation when reducing carbohydrate intake, especially if they are not consuming enough fiber from non-carb sources like vegetables.
CONCLUSION • A holistic approach is needed to promote the concept of healthy nutrition in whole country • The initiative should be taken right from childhood in schools, child care centers and families so that foundation stone of healthy eating habits is laid down in right age and can be propagated in future generations well. • Availability of nutritious foods at low cost should be ensured by policy making, mobilizing community and health education
REFERENCE • Healthy diet. WHO. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed on 17th July 2016 155 • Clemente-Suárez VJ, Mielgo-Ayuso J, Martín-Rodríguez A, Ramos-Campo DJ, Redondo-Flórez L, Tornero-Aguilera JF. The Burden of Carbohydrates in Health and Disease. Nutrients. 2022 Sep 15;14(18):3809. doi: 10.3390/nu14183809. PMID: 36145184; PMCID: PMC9505863. • Tungare S, Paranjpe AG. Diet and Nutrition to Prevent Dental Problems. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534248/ • Rugg-Gunn, A. J. (2014). Nutrition and Dental Health. G. P. Putnam’s Sons • Newbrun, E. (1978). Cariology. Baltimore: Williams and Wilkins
Thank you

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carbohydrates and its classification and application

  • 1. CARBOHYDRATES DR LAKSHMI J 1ST YEAR MDS DEPARTMENT OF PUBLIC HEALTH DENTISTRY
  • 2. CONTENTS  Introduction  History  Functions  Classification-monosaccharides Oligosaccharides Polysaccharides  Dietary guidelines  Digestion of carbohydrates  Absorption of carbohydrates  Metabolism  Carbohydrates and oral health  Nutritional programs in India  Public health significance  Clinical significance  Conclusion  Reference
  • 3. HISTORY • In nutritional terms, the diet of prehistoric man and his ancestors was rich in proteins, moderately rich in fat and usually poor in carbohydrate. • Later with the knowledge of fire and evolution of farming the ancestral man began the consumption of tuberous roots and inner barks of trees , nuts and seeds
  • 4. INTRODUCTION • Carbohydrates are the most abundant of all the organic compounds in nature. • Composed of carbon, hydrogen, and oxygen. • The word Carbohydrate means ‘hydrates of carbon’. • Defined as polyhydroxy-aldehydes or ketones or compounds which produce them on hydrolysis.
  • 5. FUNCTIONS • They are the most abundant dietary source of energy for all organisms. (4 Cal/g) • Precursors for many organic compounds ( fat, amino acid) • Structural compound of many organism fibers(cellulose) plants exoskeleton insects cell wall microorganisms
  • 6. • Carbohydrates as glycoprotein and glycolipids participate in the structure of cell membrane and cellular functions such as cell growth, adhesion and fertilization. • Serve as a storage form of energy (glycogen) to meet the immediate energy demands of the body
  • 8. CLASSIFICATION OF CARBOHYDRATES MONOSACCHARIDES (MONOSES OR GLYCOSES) OLIGOSACCHARIDES) MO NOS ACC HA RID ES OLI GOS ACC HA RID ES POL YSA CC HA RID ES Glucose ,Fructose,Galactose Maltose,Lactose,Sucrose HETERO Mucopolysaccharides, glycoproteins Agar and pectin HOMO Starch glycogen cellulose
  • 9. MONOPOLYSACCHARIDES • Sweet to taste-simple sugar • Crystalline in structure • Soluble in water • Cn(H2O)n • Cannot be further hdrolysed • Exhibits sterioisomerism –same structure,different spacial arrangement
  • 10. Based on functional group Aldose ketose Based On No: Of Carbon Atom Triose Tetrose Pentose Hexose Heptose Functional group- aldehyde Eg-glyceraldehyde glucose Functional group-keto group Eg- dihydroxyacetone fructose 3C glyceraldehyde 4C D-erythrose 5C D-Ribose D-Xylose 6C D-Glucose D-Fructos3e D-Galactose 7C Sedoheptulose
  • 11. GLUCOSE • OCCURRENCE- As a constituent of a. Polysaccharides-starch,cellulose,glycogen b. Disaccharides-maltose,lactose,sucrose • BIOCHEMICAL IMPORTANCE a. Sugar fuel of life b. Excreted in urine in diabetes c. Structural unit of cellulose in plants
  • 12. GALACTOSE • OCCURRENCE- As constituent of lactose-milk sugar • BIOCHEMICAL IMPORTANCE- a. Normally Converted Into Glucose b. Failure Will Lead To Galactosemia
  • 13. FRUCTOSE • OCCURRENCE- a. Fruits and honey b. As A constituent of sucrose and inulin • BIOCHEMICAL IMPORTANCE a. Its phosphates are intermediate of glycolysis
  • 14. OLIGOSACCHARIDES • Sweet To Taste • Crystalline Structure • Contains 2-10 monosaccharides which are liberated on hydrolysis Based On no;of Monosaccharides Disaccharides Tri Tetra Penta …………………………………Etc
  • 15. DISACCHARIDES • Most common • Contains 2 monosaccharides • Held together by glycosidic bond TYPES REDUCING NON REDUCING Contains free aldehyde and keto group Eg- maltose lactose Doesn’t have free aldehyde and keto group Eg- sucrose trehalose
  • 16. MALTOSE • α D-Glucose α D-Glucose α(1-4) Glycosidic bond • Reducing property and osazone formation- free aldehyde group on C1 of 2nd glucose • Maltose 2α DGlucose hydrolyzed by dilute acid/maltase
  • 17. SUCROSE (non reducing ) • Cane sugar- produced by sugar cane and sugar beets • α-D glucose β D fructose Glycosidic bond (α1- β2) • No free aldehyde or keto group- no osazone formation • Important source of dietry carohydrate • Sweetening agent • Sucrose Glucose+Fructose Hydrolysed by Sucrace (intestinal enzyme)
  • 18. LACTOSE(reducing) • Milk sugar –found in milk • β D galactose β D Glucose β(1-4) glycosidic bond • Reducing property and osazone formatiom- C1 carbon is free in glucose • Main source of nutrition in young mammels • Lactose Glucose + Galactose Hydrolysed by lactase (intestinal enzyme)
  • 19. POLYSACCHARIDES • Consist of repeat units of monosaccharides or their derivatives,held together by glycosidic bond • Primary function – structural and storage of energy • Polysaccharides are linear and branched TYPES Homopolysaccharides Heteropolysaccharides
  • 20. HOMOPOLYSACCHARIDES • On hydrolysis produce similar or single type of mmonosaccharides • eg  Glucans  Fructosans  Glycogen  Cellulose  Chitin
  • 21. Starch • Carbohydrate resourse of plants- dietrysourse of higher animals including man • High content Cereals Roots Tubes Vegetables • Homopolymer of D- Glucose Alpha- Glycosidic bond Glucosan Glucan
  • 22. 2 polysachharides Water soluble amylopectin 80-85% Water soluble amylose 15-30% Linear unbranched chain Branched chain Starch Amylase act on alpha 1-4 glycosidic bond In saliva and pancreas Dextrins, Isomaltose maltose
  • 23. Glycogen • Carbohydrate reserve in animals • Animal starch • High in Liver, muscles, Brain • Found in plants without chlorophyll Yeast , fungus • Structure Similar to amylopectin ( branch) • Glucose repeating unit • Alpha(1-4) glucose bond and alpha (1-6) glucose bond
  • 24. CELLULOSE • Exclusively in plants • Abundant organic sub in plant kingdom • Absent in animal body • β D GLUCOSE β D glucose β(1-4) glycosidic bond Cannot be digested by mammels lack enzyme that cleave β (1-4) glycosidic bond- but contain fiber- decrease absorption of glucose and cholestrol from intestine Cellulose cellubiose+ β D glucose hydrolysis
  • 25. HETEROPOLYSACCHARIDES • On hydrolysis yield mixture of monosaccharides • eg-  Mucopolysaccharides hyaluronic acid,chondroitin sulfate,Heparin,dermatan sulfate Agar and pectins Glycoproteins
  • 26. MUCOPOLYSACCHIRIDES • Heteroglycans made of repeating units of sugar derivatives like amino sugar and uronic acid– GAG • Acid mucopolysacchrides- sulfate and carboxyl group – acidity • Monopolysacchrides + proteins – mucoproteins / mucoids/proteoglycans-95% carb & 5% protein • Essential compound of tissue structure
  • 28. AGAR AND PECTINS AGAR • sea weeds • Polymer-galactose sulfate and glucose • Serves as dietry fibers PECTINS • Apple and citrous fruits • Contain – galactouronate and rhamnose
  • 29. GLYCOPROTEINS • Protein + carbohydrate –through covalent bond • Carbohydrate content varies from – 1% to 90%
  • 30. DIETARY GUIDELINES • Carbohydrates are major sources of energy in all human diets. • They provide energy of 4 Kcal/g. • In India, 70-80% of total dietary calories are derived from carbohydrates present in plant foods such as cereals, millets and pulses.
  • 32. A healthy diet of carbohydrates should include: Energy intake (calories) should balance energy expenditure. Limiting intake of free sugars to less than 10% of total energy. At least 400 gm of fruit and vegetables must be included every day in diet(raw and fresh preferably)
  • 33. BALANCED DIET? • A balanced diet is one which provides all the nutrients in required amounts and proper proportions. • It can easily be achieved through a blend of the four basic food groups. (fruits, legumes, whole grains and vegetables)
  • 34. •The quantities of foods needed to meet the nutrient requirements vary with age, gender, physiological status and physical activity. • A balanced diet should provide around 50-60% of total calories from carbohydrates, preferably from complex carbohydrates, about 10-15% from proteins and 20-30% from both visible and invisible fat.
  • 35. IMPORTANCE OF DIET DURING DIFFERENT STANGES OF LIFE
  • 39. GLYCAEMIC INDEX • It is defined by the area under the two-hour blood glucose response curve following the ingestion of a fixed portion of test carbohydrate as a proportion (%) of the AUC of the standard. • Some foods containing different fractions of soluble and insoluble fibres favour slow release of sugar into small intestine and its absorption into blood. • Used in management of diabetes and control of obesity
  • 41. DIGESTION PRINCIPLE DIETRY CARBOHYDRATES • Polysacchrides- starch and glycogen(major , on heating it gets hydrated and good for digestion) • Disacchrides-lactose and sucrose • Monosacchrides- glucose and fructose ( minor ) • Occours 1. Breifly in mouth 2. Largly in intestine
  • 43. ABSORPTION • Occurs in – DUODENUM and JEJUNUM(upper) • Glucose • Fructose • Galactose Absorption
  • 45. GALACTOSE – similar to glucose PHLORIZIN – blocks Na dependent transport of glucose and galactose FRUCTOSE – • Facillited diffusion mediated by carriers • No energy and Na dependency • Inside the cell – frusctose glucose capillaries PENTOSE –simple diffusion
  • 46. NON DIGESTABLE CARBOHYDRATES • Plant foods – high fibers- cannot be digested ( human enzyme and intestinal bacteria) • Fibers – chemically complex carbohydrate Eg –  cellulose  Hemicellulose  Pectin  Lignin  gums
  • 47. METABOLISM • GLYCOLYSIS • CITRIC ACID CYCLE • GLUCONEOGENESIS
  • 51. CONCLUSION • A holistic approach is needed to promote the concept of healthy nutrition in whole country and Multi-sectoral innovative approaches to involve all age groups, keeping in view cultural diversity in food habits and earning capacity is required to make people aware of importance of healthy nutrition. • The initiative should be taken right from childhood in schools, child care centers and families so that foundation stone of healthy eating habits is laid down in right age and can be propagated in future generations well. • Availability of nutritious foods at low cost should be ensured by policy making, mobilizing community and health education
  • 52. REFERENCE • Hardy K, Brand-Miller J, Brown KD, Thomas MG, Copeland L. The importance of dietary carbohydrate in human evolution. The Quarterly review of biology. 2015 Sep;90(3):251-68. • • Yudkin J. Evolutionary and historical changes in dietary carbohydrates. The American journal of clinical nutrition. 1967 Feb 1;20(2):108-15. • • K Park, Textbook of Preventive and Social medicine, 23rd edition. • • U Satyanarayana. Text Book of Biochemistry. Elsevier Health Sciences, 2014. • Healthy diet. WHO. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed on 17th July 2016 155
  • 53. CARBOHYDRATES PART 2 DR LAKSHMI J 1ST YEAR MDS DEPARTMENT OF PUBLIC HEALTH DENTISTRY
  • 54. CONTENTS  Introduction  History  Functions  Classification-monosaccharides Oligosaccharides Polysaccharides  Dietary guidelines  Digestion of carbohydrates  Absorption of carbohydrates  Metabolism  Carbohydrates and oral health  Clinical significance  Conclusion  Reference
  • 55. The Impact of Carbohydrate Quality on Dental Plaque pH •A study investigated the effect of different starchy foods varying in their glycemic index (GI) on acute changes in dental plaque pH. •Higher GI starchy foods (such as white bread) produced greater acute plaque pH decreases and larger overall postprandial glucose responses compared to lower GI starchy foods (like canned chickpeas). CARBOHYDRATE AND ORAL HEALTH
  • 56. STEPHANS CURVE • The pH of dental plaque under resting conditions (i.e., when no food or drink has been consumed), is fairly constant. •The response after exposure of dental plaque to a fermentable carbohydrate is that pH decreases rapidly, reaching a minimum in approximately 5 to 20 minutes. •This is followed by a gradual recovery to its starting value, usually over 30 to 60 minutes.
  • 57. DENTAL CARIES •Diet and nutrition may interfere with the balance of tooth demineralization and remineralization in several ways. •The diet provides sugars and other fermentable carbohydrates, which are metabolized to acids by plaque bacteria . •The resultant low pH favors the growth of the acidogenic and aciduric bacteria (mutans streptococci). •Sucrose facilitates the colonization of teeth by mutans streptococci and their outgrowth
  • 58. SALIVA •Nutrition may affect both the anatomy and function of salivary glands . •Chronic malnutrition may reduce the secretion rate of saliva and the buffer capacity of stimulated saliva but not that of unstimulated saliva . •Malnutrition can adversely affect the volume, antibacterial properties, and physiochemical properties of saliva.
  • 59. PERIODONTITIS •Periodontal disease is an inflammatory response to bacterial products in dental plaque; it is an oral infectious disease that affects the supporting structures of the teeth. •No substantive data support a relation between intake of dietary sugars and risk of or progression of periodontal disease.
  • 61. •The sugars most commonly found in an average diet are sucrose, glucose, fructose, lactose, and maltose, from which some regard sucrose as the most cariogenic. •When assessing a patient’s diet, it is essential to differentiate between natural and added sugars. •Role of sucrose in etiology of caries is strong and is based on epidemiological studies and controlled human and animal studies
  • 62. •Natural sugars do not play a significant role in developing dental caries and other non-communicable diseases. •This is probably due to their protective components (polyphenolic compounds, calcium, water, and fiber) and the hardness of some fruits and vegetables, which stimulates saliva production.
  • 63. SUGAR INTRINSIC SUGAR Inside the cell Fresh fruits and vegitables NON MILK SUGARS Table sugar Honey Fruit juice MILK SUGARS lactose EXTRINSIC SUGAR Outside the cell
  • 64. Food and beverages Plaque microflora Fermentation Organic acid production Demineralization of tooth structure(Ph-5.5) Caries
  • 65. Caries inducing potential of individual food can be measured by 3 methods In vitro model Monitoring the plaque PH change Animal testing 1. Adhesiveness of food 2. Enamel demineralizatio n 3. Production of titratable acid 4. Artificial mouth here the acidogenicity is tested either by 1. Invivio 2. Invitro Invito testing
  • 66. Sugar and dental caries : factors affecting- 1. Type of sugars 2. Consistency of sugars 3. Frequency of consumption of sugars 4. Concentration of sugars
  • 67. Type of sugars • Commonly available sugars- glucose, sucrose ,fructose, galactose and lacctose • Newburn 1967- sucrose is the arch criminal of dental caries Animal experiments shows that The group with high sucrose- shows more dental caries Ability of sucrose to encourage extensive production of dextran production in plaque
  • 68. Starchy Food • Dietary starches refer to a variety of food rich in starch (a polymeric carbohydrate), including bread, pasta, potatoes, potato products, rice, oats, breakfast cereals, and other grains. • Dietary starches are of low cariogenicity. • Experiments in animals have demonstrated that raw starch has a low cariogenic potential; however, cooked starch is between a third and a half as cariogenic as sucrose. • Furthermore, combining sucrose and starch is possibly more cariogenic than sugar.
  • 69. The Adhesiveness of Sugar • The adhesiveness of food is directly related to its cariogenic potential. • If the form of sugar has a great tendency to adhere to dental surfaces, the risk of caries increases. • Adhesion – interproximal area and occlusal area • Tackiness- ability of food to get stuck when little amount of force is applied. Seen in B/L/P area
  • 70. Frequency of Sugar Consumed • Sugar consumption positively correlates with the development of dental caries. • Enamel is demineralized every time sugar is consumed, defined as a demineralization attack, and the demineralization increases with the frequency of such episodes.
  • 71. •Konig et al – )animal experiment )states that even when total amount of sugar taken is same in different group of rats, the group with increased frequency of consumption has more caries •Firestone et al – dental caries decrease when the length of meal is increased •Vipeholm study – 24 toffe group- consumed sweet between meal develeoped more caries than other group
  • 72. Concentration of sugar • The amount of sugar consumed also influences the severity of dental caries. • As concentration increases - dental caries also increases • Studies- same frequency but different concentration of sugar then higher concentration – more dental caires • Tristan de cunha- DC increases as sugar increases • Wartime- sugar decreases- DC decreases
  • 73. DIET AND DENTAL CARIES EVIDENCES OBSERVATIONAL STUDIES INTERVENTIONAL STUDIES ANIMAL EXPERIMENTS ENAMEL SLAB EXPERIMENT PLAQUE PH EXPERIMENTS INCUBATION
  • 74. Study Name Vipeholm Study Year Conducted from 1945 to 1955 Location Vipeholm Institution for the Mentally Subnormal in Lund, Sweden Aim To investigate the effects of different forms and frequencies of sugar consumption on dental caries among institutionalized adults Method Participants were divided into different groups with varying levels of sugar intake and exposure frequency(7) Sugar was provided in various forms such as toffee, caramel, and sweets. Results Increased rates of dental caries were observed in groups with higher sugar consumption, especially those with frequent sugar exposure. Individuals who consumed sugar between meals had more severe tooth decay compared to those who consumed sugar with meals. Conclusion The study conclusively demonstrated the strong association between high sugar consumption and the development of dental caries. It highlighted the importance of sugar intake frequency, showing that consuming sugar between meals had a greater impact on tooth decay.
  • 75. Study Name Turku Sugar Study Year Conducted from 1972 to 1974de Location Turku, Finland Aim To compare the cariogenicity of sucrose, fructose and xylitol Method 125 young adult 3 groups –sucrose,fructose and xylitol Results 1st year- caries in sucrose=fructose,xylitol no caries 2nd year-sucrose-caries increased Fructose-unchanged Xylitol-almost no caries Conclusion Fructose- less cariogenic than sucrose Xylitol - noncariogenic
  • 76. Study Name Hopewood House Study Year Conducted from 1940s to 1950s Location Hopewood House, a vegetarian community in New South Wales, Australia Aim To investigate the effects of a vegetarian diet (low in refined sugars) on dental caries in children Method The study included children living at Hopewood House, a community following a strict vegetarian diet. The diet consisted mainly of whole grains, fruits, vegetables, and dairy, with minimal processed or refined sugars. Results Children at Hopewood House had significantly lower rates of dental caries compared to the general population. The prevalence and severity of dental caries were notably reduced in children following the vegetarian diet. The prevalence and severity of dental caries were notably reduced in children following the vegetarian diet. Conclusion The Hopewood House Study demonstrated the benefits of a vegetarian diet, low in refined sugars, for dental health. It highlighted the importance of whole foods and minimal processed
  • 77. Study Title Hereditary Fructose Intolerance (HFI) Study Year Conducted from various years, ongoing research Location Multiple locations where HFI patients were studied Aim To investigate the dental health outcomes of individuals with Hereditary Fructose Intolerance (HFI) Method -The study involved individuals diagnosed with HFI, a genetic disorder affecting the ability to metabolize fructose properly. -HFI patients were monitored for dental caries incidence and severity over time. -Researchers compared the dental health of HFI patients to control groups without HFI. Results -Individuals with HFI were found to have a higher prevalence of dental caries compared to the control groups. -The severity of dental caries in HFI patients was notably higher, especially in those who consumed fructose-containing foods. -The study highlighted the importance of dietary management in HFI to prevent tooth decay. Conclusion -It emphasized the need for strict dietary management, including avoiding fructose- containing foods, to maintain oral health in HFI patients.
  • 78. Study Name Tristan da Cunha Study Year Conducted from 1950s to 1960s Location Tristan da Cunha, a remote island in the South Atlantic Ocean Aim To investigate the dental health outcomes of a population with limited access to refined sugars and modern dental care Method -The study focused on the isolated population of Tristan da Cunha, who had minimal access to refined sugars -Dietary analysis was conducted to assess the types and quantities of foods consumed by the population. -Dental examinations were performed to evaluate the prevalence and severity of dental caries.. Results -The population of Tristan da Cunha had remarkably low rates of dental caries compared to more industrialized populations. -The prevalence and severity of dental caries were notably reduced, likely due to the absence of refined sugars in the diet. -The study highlighted the impact of a diet low in refined sugars and processed foods on dental health. -The Tristan da Cunha Study demonstrated the benefits of a diet low in refined sugars in preventing dental caries.
  • 79. ANIMAL EXPERIMENTS • Aspects of diet –sugar content , frequency,content of diet other than sugar can be controlled • total experiment period is less • Rats, hamsters and monkeys are used • Disadvantage- difficulty in extrapolating the findings to humans
  • 80. Enamel slab method • Observe the effect of diet in dental caries in slab of enamel which are held in mouth of humans in a removable plate constructed like a partial denture or orthodontic appliances • Then patient can be fed with the desired diet or the appliance can be taken out and place it in the desired solution.
  • 81. Plaque PH experiments • Investigate the effect of food meals or components of food on the PH of dental plaque • Easy to do • Measure the acidogenicity instead of cariogenicity of diet
  • 82. Incubation method • weakest and the simplest method • Test food are incubated with plaque or saliva and the rate of acid production is recorded  Rapid acid production- food is cariogenic  Slow acid production – little clinical significance • Disadvantage -The important aspect of dental caries (that is saliva )cannot be reproduced outside the mouth.
  • 83. CLINICAL SIGNIFICANCE INCREASED LEVELS OF CARBOHYDRATE 1. Weight Gain: • One of the most immediate effects of excess carbohydrate consumption is weight gain. • Carbohydrates are a primary source of energy, and when they are consumed in excess of what the body needs for energy, they are converted into glycogen and stored in the liver and muscles. • However, once these glycogen stores are full, the excess carbohydrates are converted into fat and stored in adipose tissue, leading to weight gain.
  • 84. 2.Increased Blood Sugar Levels •Consuming too many carbohydrates, especially those with a high glycemic index (rapidly raising blood sugar), can cause spikes in blood sugar levels. •This can lead to a temporary energy boost followed by a crash, leaving one feeling fatigued, irritable, and hungry again shortly after eating.
  • 85. 3.Insulin Resistance • Excess carbohydrate intake over time can lead to insulin resistance. When the body consistently has high levels of blood sugar due to excessive carbohydrate consumption, the pancreas produces more insulin to help regulate blood sugar levels. •Over time, the cells become less responsive to insulin's signals, leading to insulin resistance, a precursor to type 2 diabetes.
  • 86. 4.Increased Risk of Type 2 Diabetes: • Prolonged excessive carbohydrate intake and subsequent insulin resistance can ultimately lead to the development of type 2 diabetes. •The body's inability to effectively regulate blood sugar levels can result in chronically elevated blood sugar, causing damage to blood vessels and organs.
  • 87. 5.High Triglycerides: •Diets high in simple carbohydrates (like sugar and refined grains) can lead to elevated triglyceride levels in the blood. • High triglycerides are a risk factor for heart disease. 6.Risk of Metabolic Syndrome • Metabolic syndrome is a cluster of conditions that occur together, including increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. • Excessive carbohydrate consumption, particularly of refined carbohydrates, is linked to an increased risk of developing metabolic syndrome.
  • 88. 7.Increased Risk of Cardiovascular Disease •Excessive carbohydrate consumption, especially when it leads to weight gain and high triglycerides, can increase the risk of cardiovascular disease. •This includes conditions such as heart attack, stroke, and atherosclerosis.
  • 89. 8.Gut Health Issues •Diets high in certain types of carbohydrates, particularly refined sugars, can negatively impact gut health by promoting the growth of harmful bacteria and reducing the population of beneficial bacteria. •This imbalance can lead to digestive issues, inflammation, and a weakened immune system.
  • 90. Decreased levels of carbohydrates 1.Keto Flu •When transitioning to a very low-carb or ketogenic diet, some people may experience symptoms like headaches, fatigue, irritability, and dizziness. •This is often referred to as the "keto flu" and is temporary as the body adjusts to using ketones for energy.
  • 91. 2.Nutrient Deficiencies • Carbohydrates are a source of important nutrients like fiber, vitamins, and minerals. •Drastically reducing carbohydrate intake without careful planning can lead to deficiencies if these nutrients are not adequately replaced through other food sources or supplements. .
  • 92. 3.Reduced Athletic Performance •Carbohydrates are the body's preferred source of fuel for high-intensity exercise. •Athletes who engage in intense training may find their performance impacted by a low-carb diet, especially during sprinting or high-intensity workouts.
  • 93. 4.Digestive Issues • Some people may experience constipation when reducing carbohydrate intake, especially if they are not consuming enough fiber from non-carb sources like vegetables.
  • 94. CONCLUSION • A holistic approach is needed to promote the concept of healthy nutrition in whole country • The initiative should be taken right from childhood in schools, child care centers and families so that foundation stone of healthy eating habits is laid down in right age and can be propagated in future generations well. • Availability of nutritious foods at low cost should be ensured by policy making, mobilizing community and health education
  • 95. REFERENCE • Healthy diet. WHO. http://www.who.int/mediacentre/factsheets/fs394/en/. Accessed on 17th July 2016 155 • Clemente-Suárez VJ, Mielgo-Ayuso J, Martín-Rodríguez A, Ramos-Campo DJ, Redondo-Flórez L, Tornero-Aguilera JF. The Burden of Carbohydrates in Health and Disease. Nutrients. 2022 Sep 15;14(18):3809. doi: 10.3390/nu14183809. PMID: 36145184; PMCID: PMC9505863. • Tungare S, Paranjpe AG. Diet and Nutrition to Prevent Dental Problems. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534248/ • Rugg-Gunn, A. J. (2014). Nutrition and Dental Health. G. P. Putnam’s Sons • Newbrun, E. (1978). Cariology. Baltimore: Williams and Wilkins

Editor's Notes

  • #6: Associated with other entities such as glycosides, vitamins and antibiotics.
  • #32: Unsaturated fats (e.g. found in fish, avocado, nuts, sunflower, canola and olive oils) are preferred over saturated fats (e.g. found in fatty meat, butter, palm and coconut oil, cream, cheese, ghee and lard).
  • #44: ORAL REHYDRATIO THERAPY PIC
  • #69: However, the cariogenic potential of foodstuff with low stickiness, like drinks high in sugar, should not be underestimated as they significantly increase the risk of dental caries.