This week, you will learn about carbohydrates.
There are general dietary requirements, whether in foods,
how our bodies process them, and how are they're utilized.
Whole grains, fruits and vegetables are important parts of the nutritious diet
and are healthy sources of carbohydrates. Added sugars may not provide nutrition,
but that does not mean we can never have a slice of pie or sweeten our tea.
Relatively, recently, carbohydrates of a whole have gotten a bad-rap and that was
true, excess sugar intake is associated with disease risks and increases in
morbidity. We cannot simply say that all sugars, all carbohydrates are bad.
It's not just about the simple sugar. Whole grains, fruits, vegetables, these
are all carbohydrates. Fruits contain sugar and in moderation,
sugar can be a part of a healthy diet. So carbohydrates as a whole, have been
framed for crimes they did not commit, at least not alone.
Sugar has been accused of causing diabetes,
cavities, hyperactivity, and weight gain. And though sugar may be playing a roll in
all these conditions, sugar itself does not cause any of them.
So let's consider the evidence behind each accusation. Can sugar cause
diabetes? Type 1 diabetes is an autoimmune disorder,
regardless of what a person with type diabetes eats, they will always have it.
Proper nutrition is part of managing type 1 diabetes, but it's not cause for
malnutrition. Type 2 diabetes has many causes.
It's a multifactorial disease progressing from insulin insufficiency or resistance.
Once someone has diabetes, a good diet with regulated carbohydrate intake will
be part of the treatment playing. First factors for developing insulin
resistance include obesity, high blood pressure, high cholesterol,
sedentary lifestyle, genetics, polycystic ovary syndrome, and aging.
It's a much more complex than sugar causes diabetes.
And we see, as life goes along, we roll around and our bodies deteriorates
depending on how well we do or do not take care of them.
We cannot isolate any one of these as causing diabetes.
They are certainly part of a process, and then, once someone is diabetic, these are
all conditions one would want to manage and one would also want to manage their
carbohydrate intake, but again, we cannot say sugar makes you become diabetic.
Is sugar rotting your teeth or a little sugar monster is chipping away at your
teeth with every bite? Well, just like diabetes, the development of dental care
is, is also a multi, multifactorial phenomenon.
While sugar fuels the organism responsible for dental demineralization,
sugar at own does not break down tooth enamel.
The bacteria responsible for this process is s mutans.
Caries its caries formation will begin with a demineralization of tooth enamel
from the acids in the mouth. The activity of this s mutans actually
will cause this acid production, as well as any acid that you consume like orange
juice is an acidic food that will add to the acidic environment.
So, this s mutans who metabolize specifically from minimal carbohydrates
that you eat. So whether that be a cookie or a caramel
bread orange juice, the bacteria will break it down, and
there, metabolic processes produce acids in the mouth.
Over time, these acids will continue to build up to a point where you can change
the ph of your mouth. Once you change the ph of your mouth,
demineralization will begin. In addition to this, the process of this
bacteria also induces the formation of plaque and these pockets of plaque on
your teeth enhance the environment and make it hospitable for the s mutans to
continue with s production, acidifying the mouth, and causing
demineralization of the tooth. A demineralization continues if it
reaches the dentin as you continue to eat.
Over time, we can break it down enough to cause a carie.
Now, we think about what kind of foods are bad here or less healthful.
The foods that are responsible are any fermentable carbohydrate.
An apple, an orange, a caramel, a soda, a candy bar.
Some foods are less cariogenic than others,
that means they have less capacity to cause caries and also the ph of a food
will have an impact here. Well, think about some of the foods maybe
you could've chosen for oral health. Oral hygiene is always important keeping
the mouth clean, keeping debris off the mouth. It's going to be very important.
We're just going to focus a little bit on food component here.
So, let's think of some foods you might choose.
How about an apple and cheese? Well, the apple has sugar as a fruit.
The cheese does have some sugar. It's, it is based of milk.
So there is some amount of carbohydrate in both,
but this is not a very sticky food. It's not going to stick to your teeth.
The fresh apple, the uncooked, unprocessed apple is less
cariogenic than a processed apple would be.
But, especially, if you added sugar to the
apple and made like a dessert and certainly apple acids sitting on your
teeth long term might not be good, but that's not one we consider highly highly
problematic. How about some soda and pasta? Well,
there's sugar in the soda and in the pasta, and there's acids in the soda.
So these are formidable plus acidic, so yesm they certainly would lend themselves
more [INAUDIBLE] demineralization or to exasperating demineralization.
Milk and carrots, okay again, both have sugar,
but their forms are less cariogenic. How about orange juice and a breakfast
muffin? While orange juice is certainly helpful,
it's got vitamin C, it's a nice part of your breakfast.
A breakfast muffin, well, you know, it certainly could be a choice.
It might be less helpfu, but Combined with foods from animal carbohydrates,
potentially that stickiness of that muffin and the actives in your juice are
going to promote demineralization in carriage formation.
How about veggies and the chicken? Well, these are also going to change some
carbohydrates probably have certain half carbohydrates, but they are not going to
be highly cariogenic and not highly suitable for eating and demineralization.
So I've used some terminology and listed some different foods that might be
increasing the risks of developing dental caries.
Foods that are going to be inducing more demineralization because of what they do
to the oral environment and these terms that I've used just to help you
understand what they are. Acidic foods can be termed acidogenic,
they do decrease the oral pH quickly. Cariogenic foods are the fermentable
carbohydrates as I mentioned that will be metabolized by the bacteria in your mouth
to also reduce the pH in the mouth. Cariostatic foods, now, they do contain
some sugars, but they're really not metabolizing by the bacteria into a point
where they're going to actually drop the pH of your mouth.
And lastly, anticariogenic foods that I didn't mention, but which are very
important, can actually prevent cariogenic activity and the two that
really come to mind are xylitol in sugar free gums and cheese.
So cheese is actually a really great healthy snack option, for example.
We'll talk a little bit about this in future lectures.
But in pregnancy, one might want to eat smaller, more frequent meals if one's
feeling significant amounts of nausea and a healthy snack for keeping good oral
health in pregnancy would be a low fat cheese stick.
This will be much better than something that seems healthy like a granola bar.
A granola bar is sticky, a fermentable carbohydrate and it would be more likely
to induce demineralization and various development.
Another thing that's very important is how often you eat and what type of foods
are in your meals or snacks together. So if you eat, eat more often then
there's more chances that you're bringing in fermentable carbohydrates, potentially
acids and you are activating those bacteria, so each time you eat, that pH
could drop, the more often the pH drops the more likely you are going to see
demineralization occur. So, more often, eating more often would
be a risk factor for higher chances of developing dental caries.
Also, if we have snacks that are high in fermentable carbohydrates and that's all
they're made of, so a snack, like I just said, a granola bar versus a cheese
stick, that snack has nothing else in it. It's going to be more likely to induce
the development of dental caries. If I have that granola bar in a meal
where there's lots of other foods, so maybe it was part of my lunch.
I had a granola bar with a cup of yogurt and a nice bottle, cup of water to go
with that those foods would combine to decrease what's happening in the mouth.
Another thing that's important is rinsing the mouth out so those fermentable
carbohydrates don't stay there and that's done with basic water and also making
sure that you have enough saliva. Individuals with conditions such as dry
mouth also have a higher risk for developing dental cavities, because the
saliva isn't there to help [UNKNOWN] the mouth.
Alright. So does sugar cause hyperactivity? Was it that candy bar that
got your kids running and screaming through the market? Well, even though it
might seem like it, sugar is not the best choice for a growing child, but it's not
going to cause hyperactivity. Now, it might spike blood sugar and have
other negative effects if eaten in excess, but it's not causing the
hyperactivity. While I'm free of being, blaming
stimulants like caffeine and sugar, poor nutrition and micronutrition imbalances
can have detrimental hormonal effects and the treatment of chronic malnutrition has
been associated with improvements in behavioral issues,
but overall, we can't just blame sugar. That's much too simplistic.
There's far more at play here. Good healthy diet is very important for
having a healthy child that does behave properly and even so a child with a very
healthy diet may still have other factors coming into play that can lead to
behavioral problems. How about weight gain? Can we blame the
carbon sugar for tipping the scale? Now, they have been the target of ketogenic
diets like the Atkins diet or South Beach diet and low fat craze is widespread,
we can see it on our supermarket shelves. This comes about because people are
struggling to find an easy solution for their battle with obesity,
and the hardest part about weight management is not what you should or
should not eat. We know what we should or should not eat
or at least what we should eat more or less of, but it's making that happen.
So combining our food choices with dealing practical, financial, emotional
challenges, limitations in time and energy, overcoming stress or lack of
motivation. Those I would say are far more likely to
blame for our challenges with food. If we wanted to blame any sugar, we would
maybe look to the added sugars in our food.
These are going to be less satisfying and less satiating and we're more likely to
overeat sugary, empty calorie foods than a high fiber carbohydrates.
So if we think about this, let's break this down.
If you, your body, burns 1, 953 calories a day and you eat 1,950 calories a day,
just carbohydrates. Maybe just apples, for example, or just
grapes. Will you gain weight? Now, even if
they're just Twinkies, you're not going to gain weight.
Can we blame certain foods for tipping the scale without regard to the quantity
we consumed? How easy would it be to eat 1,500, 1,900, calories of apple versus
1,500, 1,900, calories of icecream? So if you're still guessing, the answer
is no, carbohydrates don't make us fat.
Calories, in excess, increase fat deposition and do lead to weight gain.
There's no one food to blame for tipping the scale,
even the cupcakes, veggies, burgers, all these foods can be part of a healthy
diet, even our party things. When think about what [UNKNOWN] this
weight gaining, again, it's not multifactorial component.
Even though, eating unhealthy might lead you to be hungry or type of vitamin or
mineral deficiency. It's more the complex components that are
going to lead to obesity. All the components to our food, the
proteins, the vegetables, the fruits, the whole grains, fiber, vitamins and
minerals, play a role in our health. We need them,
our body needs these components of food to make the machine run.
It's the details of diet that dictate how healthy you'll be.
If you're satiated by what you eat, if your body systems function normally, if
your food helps you maintain even blood sugar and healthy digestion, if you have
enough energy to do what you need to do all day long.
If your food meets your body's needs, and meets your satiety needs, and taste
needs, you're less likely to gain weight. Research indicates that the key to
healthy weight management is self-awareness and self-monitoring.
You not only know how much you're eating, you've all got an opportunity to
self-monitor. Were you surprised by what you ate? When
it comes to losing weight, burning more calories than you eat brings results.
The best way to make sure that you're doing that is to write it down.
So to summarize how can maybe carbohydrates seem to be tipping the
scale, you may have talked to a friend or heard
in the media it's the carbs that are making me fat.
When I stop eating carbs, I lose weight. It's gotta be the carbs, it jus, that
just makes sense. Well, if they're not writing what they're
eating down, they don't know for sure how many calories they were eating before
they cut carbs versus after they cut carbs.
This balance is as simple as in and out, but the awareness and actual details of
how much we're eating come to measurement.
What you choose to eat depends on cost, time, taste, and who you're responsible
for eating. Unhealthy food, empty calories, and a
diet high in added sugar is more likely to bring in more calories, even though it
does taste good, it's less filling than fiber, less satiating and much easier to
overeat. Now, when people do go on low-carb diets,
yes, there are physiological changes occurring. But over time, two individuals
on low-carb versus moderate-carb diet eating the same amount of calories,
having the same caloric need are going to both lose weight.
So if there's any one key though to healthy weight management, I would say
it's in fiber and protein with a little bit of fat.
Fiber fills you up, protein keeps you full, and fat makes things taste good.
All in moderation, again, but proper food combining the roles of food in our diet
can also be a part. I was helping manage weight more easily,
so while we're talking about sugar, let's talk about the un-sugars,
they've also been blamed for some things along the years, certainly some of them,
more and more chemical in nature than others, and some individuals may choose
not to consume them. They much rather just moderate their
sugar or sweets intake, but since we'd like to know a little bit about what they
mean and so that you can understand what they are, I will help a little bit about
those. The first artificial sweetener to appear
on the market was saccharin, tt was marketed as Sweet'N Low, and it
still is, and in addition to the tabletop sweetener, you can find saccharin in
low-sugar versions of foods, like gums or diet soda.
Saccharin isn't digestible, but it is absorbed through the gut and will be
excreted in your urine unchanged. It was the subject of some controversy
due to some findings of associations with bladder tumors developing in male rats
fed high doses of sodium saccharine, but following research did not find any
significant association in human being. That being said, it is still a chemical
that you are introducing into your body and just like every other nutrient or
non-nutrient edible product, I would say moderation is the key.
A newer sugar alternative actually derived from sugar is sucralose. It's
marketed as Splenda. Splenda's useful in cooking, because it
is highly stable and it will maintain it's sweetness.
It does not provide calories because it isn't digested and like the other
[UNKNOWN] sweeteners, it will be excreted in the urine.
A third kind of sweetener released is aspartame.
This is sold as Equal and NutraSweet. Aspartame is used in diet sodas and other
drinks. It's in processed foods and these foods
will typically be marketed as low sugar. It's also used in sweetened medications.
The compound aspartame is made of aspartic, aspartic acid and phenylalanine
with with [INAUDIBLE] Now, unlike other artificial sweeteners, aspartame cannot
be used in cooking, it will be denatured and lose its taste.
And the primary concern with aspartame is in certain individuals with
phenylketonuria or PKU. Individuals with PKU cannot digest
aspartame, it's toxic to them,
this is because they can't break down phenylalanine.
They actually are missing the enzyme phenylalanine hydroxylase or have
insufficient amounts to convert phenylalanine to tyrosine.
These are both amino acids. When you cannot convert phenylalanine to
tyrosine, phenylalanine, phenylalanine will build up in the blood and cause
toxicity, particularly in the brain. So people with PKU do need to avoid foods
rich in phenylalanine or any alternative sweetened product or any alternative
sweetened products with Equal or NutraSweet, with aspartame.
And the food levels will actually contain information about their aspartame content
and a warning. Other sweeteners may be marketed for
their anticariogenic property, as I mentioned, or the sugar alcohols.
These include sorbitol, mannitol, and erythritol.
These are digested, but not metabolized and, or they're metabolized very slowly,
and they do have minimal calories relative to sugar. Because the digestion
is slow, not all the sugar alcohol gets absorb, absorbed and some of this can
actually cause GI irritation and diarrhea .
The good news for dentists is that sugar alcohols are not metabolized by, or
bacteria. Chewing gums sweetened with sugar
alcohols can help prevent cavities, because each stick gum helps clear the
mouth, increase the saliva and there's not a fermentable carbohydrate.
Looking at a gum label, you'll actually see claims relating to artificial
sweeteners sugarless or even the claim that it does not promote tooth decay.
And again, this is because it's not broken down by bacteria.
Finally stevia is derived from a perenial shrub and is 30 times sweeter than sugar.
It's available in powder and liquid concentrate, tea, or tablet forms.
Refined stevia is considered non-nutritive and is cariostatic.
It's marketed as having no effect on blood sugar, but in current research is
still underway to determine the effects of whole leaf or crude stevia on blood
sugar, the kidneys, and the cardiovascular, and
reproductive systems. So, I hope you've learned a little bit
more about carbs and what sugar does or does not do and can now be one to help
stop blaming sugar for things that sugar was not causing.