Carbohydrates

Learning Objectives

Upon completion of this chapter, students should be able to:

1. Name the major types of carbohydrates—simple sugars, starches, and fibers—and give examples of
each.
2. Describe the basic chemical structure and properties of monosaccharides, disaccharides, and
polysaccharides, and name the members of each class that are important in human nutrition.
3. Explain the relationship between simple sugar intakes and health problems such as nutrient
deficiencies, dental caries, and obesity.
4. Make sugar intake recommendations for individuals based on the Dietary Guidelines, DRI, or WHO
guidelines.
5. Discuss how sugar alcohols differ from sugars in their effects on the body.
6. List the common artificial sweeteners available in the U.S., identify any safety issues, and discuss
their use within a weight control program.
7. Explain the benefits of dietary complex carbohydrates for prevention or management of heart
disease, diabetes, GI health, and cancer, and for weight management.
8. Make complex carbohydrate and fiber recommendations for individuals, including both appropriate
intakes and guidelines for introducing more fiber into the diet.
9. Identify carbohydrate sources from the USDA Food Guide groups.
10. Interpret information related to carbohydrates appearing on a given food label.
11. Describe the process of dental caries development, name the factors that promote or hinder it, and
provide guidelines for maintaining dental health.

Chapter Summary

Carbohydrate is the body’s preferred energy source. Six simple sugars are important in nutrition: the
three monosaccharides (glucose, fructose, and galactose) and the three disaccharides (sucrose, lactose,
and maltose). The three disaccharides are pairs of monosaccharides; each contains glucose paired with
one of the three monosaccharides. The polysaccharides (chains of monosaccharides) are glycogen,
starches, and fibers. Both glycogen and starch are storage forms of glucose—glycogen in the body and
starch in plants—and both yield energy for human use. The dietary fibers also contain glucose (and other
monosaccharides), but human digestive enzymes cannot break their bonds, so they yield little, if any,
energy.

In moderate amounts, sugars pose no major health threat. Excessive sugar intake may increase the risk of
nutrient deficiencies and dental caries, however. A person deciding to limit daily sugar intake should
recognize that not all sugars need to be restricted, just concentrated sweets with added sugars, which are
high in kcalories and relatively lacking in other nutrients. Sugars that occur naturally in fruits, vegetables,
and milk are acceptable.

Two types of alternative sweeteners are sugar alcohols and artificial sweeteners. Sugar alcohols are
carbohydrates, but they yield slightly less energy than sucrose. Sugar alcohols do not contribute to dental
caries. The artificial sweeteners are not carbohydrates and yield no energy. Like the sugar alcohols,
artificial sweeteners do not promote tooth decay.
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A diet rich in starches and dietary fibers helps prevent heart disease, diabetes, GI disorders, and possibly
some types of cancer. It also supports efforts to manage body weight. For these reasons,
recommendations urge people to eat plenty of whole grains, vegetables, legumes, and fruits—enough to
provide 45 to 65 percent of the daily energy from carbohydrate.

Grains, vegetables, fruits, and legumes contribute dietary fiber to people’s diets and, like milk, also
contribute energy-yielding starches and dilute sugars. Food labels list grams of total carbohydrate and
also provide separate listings of grams of fiber and sugar.

Lecture Outline

I. Carbohydrates: introduction
A. Carbohydrates are preferred energy source for many of body’s functions
B. Human brain depends exclusively on it as energy source
C. Carbohydrate-rich diet recommended for good health
D. Fats share fuel-providing responsibility with carbohydrates, but not normally used to fuel brain
& central nervous system
E. Other energy sources (proteins & alcohol) offer no advantage as fuel

II. The Chemist’s View of Carbohydrates

A. Introduction
1. Dietary carbohydrates include simple sugars, starch & fiber
2. Simple sugars (also called simple carbohydrates)
a. Monosaccharides (single sugars)
b. Disaccharides (double sugars)
3. Starch & fiber
a. Polysaccharides (chains of monosaccharide units)
B. Monosaccharides
1. Glucose
a. Most cells rely on glucose for fuel
b. Brain & nervous system rely on it almost exclusively
c. Body maintains blood levels of glucose within limits that allow for cell nourishment
1. Insulin moves glucose from blood into cells
2. Glucagon brings glucose out of storage
2. Fructose
a. Sweetest of sugars
b. Naturally occurring in fruits, honey & saps
c. Along with glucose, the most common monosaccarides in nature
3. Galactose
a. Primarily occurs as part of lactose
b. Known as “milk sugar”
c. Freed from lactose as single sugar during digestion
C. Disaccharides
1. Introduction
a. Pairs of single sugars linked to form disaccharides
b. All disaccharides have glucose as one of the single sugars, combined with a second

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 c. Enzymes split disaccharides into the two monosaccharides during digestion
d. Important dietary disaccharides include sucrose, lactose & maltose
2. Sucrose (white or table sugar)
a. Composed of glucose & fructose
b. Refined from juice of sugar beets or sugarcane
c. Occurs naturally in many fruits & vegetables
3. Lactose
a. Composed of glucose & galactose
b. Principle carbohydrate in milk
c. Lactose intolerance
1. Inability to digest lactose
2. Occurs in some people after infancy
4. Maltose (malt sugar)
a. Consists of two glucose units
b. Produced during breakdown of starch
c. Plants break down stored starch for energy & start to sprout
d. Occurs in humans during carbohydrate digestion
D. Polysaccharides
1. Introduction
a. Composed almost entirely of glucose (in some cases, also other monosaccharides)
b. Major polysaccharides in nutrition: starch, glycogen & fiber
1. Glycogen: storage form of energy for humans & animals
2. Starch: storage form of glucose in plants
3. Fibers: provide structure in stems, trunks, roots, leaves & skins of plants
2. Starch
a. Giant chains of hundreds of glucose units
b. All starchy foods are plants
1. Grains—richest source of starch
2. Legumes
3. Root vegetables (tubers)
c. Grains, legumes & tubers also abundant dietary supply of fiber, protein & other nutrients
3. Glycogen
a. Composed of highly branched chains of glucose units
b. Storage form of glucose
c. Stored in liver & muscles
d. Found in limited amounts in meats; not found in plant sources
4. Fibers
a. Consists of polysaccharides, found in all plant-derived foods
b. Provide little or no energy for body (bonds cannot be broken by human digestive
enzymes)
c. Bacterial digestion does yield some energy with metabolism (1.5-2.5 kcalories per gram)
d. Soluble fibers
1. Dissolve in water
2. Form gels which are easily digested by bacteria in large intestine
3. Associated with lower risks of chronic diseases

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 e. Insoluble fibers
1. Do not dissolve in water
2. Retain structure & texture
3. Aid digestive system by easing elimination

III. Health Effects & Recommended Intakes of Sugars

A. Health Effects of Sugars
1. Fiber-rich carbohydrates should predominate in the diet
2. Concentrated sweets & foods with added sugars contribute kcalories but few nutrients
3. World-wide trend in increasing sugar consumption
4. Dietary Guidelines for Americans 2005: concentrated sweets & added sugars should be treated
as discretionary kcalories
5. World Health Organization: no more than 10% of total kcalories from added sugars
6. Conclusions (from FDA):
a. Moderate amounts of sugars pose no major health risk
b. Excesses contribute to nutrient deficiencies & tooth decay
7. Sugar & nutrient deficiencies
a. Empty-kcalorie foods (containing added sugar) deliver glucose & energy, but few other
nutrients
b. In comparison, foods with natural sugars, starch & fibers that deliver protein, vitamins,
minerals, as well as glucose & energy
c. Sugar contributes to nutrient deficiencies by displacing other nutrients
d. Nutritious foods should come first in diet
8. Sugar & dental caries
a. Sugars & starches both support bacterial development in mouth—contributing to dental
caries
b. Populations with intake of <10% kcalories from sugar have low incidence of caries
c. Factors contributing to development of caries:
1. Length of time food spends in mouth
2. Composition of food
3. How sticky food is
4. How often person eats the food
5. Whether or not teeth are brushed following consumption
B. Controversies Surrounding Sugars
1. Obesity
a. Evidence shows supportive role of sugar and incidence of obesity, but no direct cause-
and-effect relationship
b. Usually, increased sugar intake also associated with greater consumption of kcalories,
processed foods, meats & fats
c. Weight gain usually associated with decline in physical activity
d. In U.S., obesity has reached epidemic proportions
e. Increased intake of food energy & sugar-sweetened beverages
f. Contribution of sugar to excessive energy intake has had role in development of obesity
2. Behavior
a. No proof that sugar causes hyperactive or aggressive behavior

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 b.Relationship of sugar to behavior problems in children may be due to replacement of
nutrient-dense foods with sugary foods
c. Lack of nutrients, not sugar itself, can contribute to undesirable behavior in children
C. Recommended Sugar Intakes
1. Moderation: enough for pleasure but not to displace more nutritious foods
2. Dietary Guidelines for Americans 2005
a. Choose & prepare foods & beverages with little added sugars
b. Used as part of discretionary kcalorie allowance in nutrient-dense diet
3. USDA Food Guide
a. 3 tsp for 1,600 kcal (a day)
b. 5 tsp for 1,800 kcal
c. 8 tsp for 2,000 kcal
d. 9 tsp for 2,200 kcal
e. 12 tsp for 2,400 kcal
4. Some sugar equivalents (1 tsp white sugar equivalency)
a. 1 tsp brown sugar, candy, jam, syrup
b. 1 Tbs ketchup
c. 1 ½ oz carbonated soft drink
5. Comparing sugar sources: orange vs. honey
a. Same sugars & about same energy as 1 Tbs sugar or honey
b. Orange also contains vitamins, minerals & fiber not found in honey
c. More nutrient density in orange
6. Sugar-sweetened soft drink
a. Contains many tablespoons of sugar
b. Few, if any, other nutrients

IV. Health Effects of Alternative Sweeteners

A. Sugar alcohols (nutritive sweeteners)
1. Carbohydrates that yield less energy than sucrose
2. Occur naturally in fruits
3. Manufactured to add sweetness & bulk to cookies, sugarless gum & candy, jams & jellies
4. Side effects of gas, abdominal discomfort & diarrhea
5. Do not contribute to dental caries
B. Artificial sweeteners (nonnutritive sweeteners)
1. Not carbohydrates; yield no energy
2. Add to sweetness of foods without promoting tooth decay
3. U.S. approved sweeteners: saccharin, aspartame, sucralose, neotame, tagatose
4. Aspartame
a. Active ingredient in NutraSweet® & Equal®
b. 200 times sweeter than sucrose
c. Extensive animal & human studies to document safety: long-term consumption found
safe & not associated with adverse health effects (exception: not safe for individuals with
PKU)
d. Despite safety documentation, consumption should be maintained below the ADI of 50
milligrams/kg in a day

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 5. Aspartame & PKU
a. Aspartame contains the amino acid phenylalanine
b. PKU (phenylketonuria): metabolic disorder in which phenylalanine cannot be disposed
of efficiently
6. Artificial sweeteners & weight control
a. Used widely to control weight
b. Some evidence that consuming artificial sweeteners has been linked with increased
feelings of hunger
c. Most studies find to the contrary
d. Using sweeteners does not automatically lower energy intake; to control energy intake,
needs to be combined with informed diet & activity decisions

V. Health Effects of Starch & Dietary Fibers

A. Introduction
1. For health, most people should increase intake of carbohydrate-rich foods
2. Emphasis on whole grains, vegetables, legumes, fruits— usually moderate in food energy,
low in fat & high in dietary fiber, vitamins & minerals
3. Help reduce risks of obesity, cancer, cardiovascular disease, diabetes, dental caries, GI
disorders & malnutrition
4. Challenge: which carbohydrates contribute which health benefits
5. Dietary Guidelines for Americans 2005
a. Daily recommendations based on energy intake of 2000 kcal/day
b. High-fiber diet, including
1. 4 ½ cups of fruits & vegetables
2. At least 3 ounces of whole grains
B. Disease Prevention & Recommendations
1. Heart disease
a. Diets rich in whole grains, legumes & vegetables (especially whole grains) may guard
against heart disease
b. Soluble fibers (oat bran, barley, legumes) lower blood cholesterol
2. Diabetes
a. Some fibers delay passage of nutrients from stomach into small intestine—slowing
glucose absorption
b. Glycemic effect: extent to which a food raises blood glucose concentration & elicits an
insulin response
3. GI health
a. Fibers that enlarge & soften stools ease elimination
b. Alleviate or prevent constipation & hemorrhoids
c. Maintain movement of contents of intestinal tract
d. Maintain health & tone of GI tract muscles; helping to guard against diverticulosis
4. Cancer – Studies have shown that increasing dietary fiber protects against colon cancer
5. Weight management
a. Fiber-rich foods
b. Tend to be low in fats & added sugars, yielding less energy per bite
c. Promote feeling of fullness as they absorb water
d. Slow movement through digestive tract, prolonging satiety

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 e. Recommended sources of fiber in weight-loss plans
1. Fresh fruits
2. Vegetables
3. Legumes
4. Whole-grain foods
6. Harmful Effects of Excessive Fiber Intake
a. May bind with minerals, resulting in losses with excretion
b. Individuals with marginal food intake overall but high-fiber diets may not meet energy
or nutrient needs
c. Malnourished, elderly, young children on all-plant diets especially vulnerable
d. Dehydration also a risk
e. Excessive fiber intake, as well as limited fluids, can obstruct GI tract
7. Carbohydrate Recommendations
a. Carbohydrates: about half (45-65%) of daily energy requirement
b. Fiber: encourage whole grains, vegetables, fruits & legumes
1. 11.5 grams/1000 kcal/day intake
2. Approximately 20-35 grams/day
c. Achieving higher fiber intakes
1. Substitute plant sources of proteins (legumes) for some animal sources
2. Consume recommended amounts of fruits & vegetables
3. Seek out variety of fiber sources
4. Drink extra fluids to ensure fiber effectiveness
C. Carbohydrate Food Sources
1. Grains
a. Most foods from group provide about 15 grams carbohydrate, mostly starch
b. Choices should be low in fat & sugar
c. Included in group:
1. 1 slice whole-wheat bread
2. ½ English muffin or bagel
3. 6-inch tortilla
4. ½ cup rice, pasta or cooked cereal
2. Vegetables
a. Some are major sources of starch; provide 15 grams carbohydrate
1. Small white or sweet potato
2. ½ cup cooked dry beans, corn, peas, plantain, winter squash
b. Non-starchy vegetables; about 5 grams carbohydrate – ½ cup carrots, okra, onions,
tomatoes, cooked greens, salad greens
3. Fruits
a. Typical serving provides about 15 grams carbohydrate
1. ½ cup juice or most canned or fresh fruits
2. Small apple, banana, orange
3. ¼ cup dried fruits
b. No more than 1/3 of day’s fruit should be from juice
4. Milk, cheese & yogurt
a. 1 cup milk or yogurt provides 12 grams carbohydrate
b. 1 cup buttermilk

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 c. a cup dried milk powder
d. ½ cup evaporated milk
e. Cottage cheese provides 6 grams per cup
f. Other cheeses provide little, if any, carbohydrate
5. Meat, poultry, fish, legumes, eggs & nuts
a. Almost no carbohydrates provided from these foods
b. Exceptions: nuts & dried beans
1. ½ cup dried beans provides 15 grams
2. ½ cup other legumes provides approximately 8 grams
D. Food Labels & Health Claims
1. Labels list
a. Amount (in grams) total carbohydrate, including starch, fiber & sugars, per serving
b. Percent of Daily Values expressed for individual consuming 2000-kcal diet
2. Authorized health claims
a. Reduced risk of cancer associated with fiber-containing grain products, fruits &
vegetables
b. Reduced risk of coronary heart disease associated with fruits, vegetables & grain
products containing fiber
c. Reduced risk of coronary heart disease associated with soluble fiber from whole oats &
psyllium seed husk
d. Reduced risk of heart disease & certain cancers associated with whole grains

VI. Nutrition & Dental Health

A. Dental caries: infectious oral disease developing in tooth enamel
B. Bacteria in dental plaque consume & metabolize carbohydrates, producing acids that attack tooth
enamel
C. Other factors influence susceptibility to dental caries
D. Saliva protects against formation of caries
E. Some foods help prevent caries by stimulating saliva flow & do not contribute to acid formation
in the mouth
F. Addition of fluoride to water supply

Worksheet 2-3: Food Examples of Nutrients and Other Food Components – Answers will vary.

Answer Key for Chapter “Clinical Applications” Questions

1. Replace refined bread and cereals with products that list “whole grain” as first item on ingredient list.
Add 2 cups of cooked and raw vegetables to the diet each day. Limit juice to ½ cup a day. Replace
hard candy “snacks” with 2 pieces of fresh fruit each day. Suggest fruit with yogurt for snacks. Eat
smaller servings of meat and replace with higher-fiber plant foods such as beans, brown rice,
vegetables and whole-grain breads.

Suggested Activities

Activity 2-1: Taste Testing

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Bring in samples of fructose from the health food store to compare its sweetness with that of sucrose. To
illustrate the differences between the taste of table sugar and alternative sweeteners, assemble samples of
cola drinks and other products such as hot chocolate in a regular version or the “dietetic” version
sweetened with aspartame or other sweeteners. Chewing gum with aspartame or sugar alcohol, dietetic
candy and puddings are convenient as illustrations of the uses of alternative sweeteners. Have the
students fill in evaluation forms rating the products on flavor, texture or consistency, appearance and
price.

Activity 2-2: Sucrose and Fat1

After students have compiled their personal dietary records and calculated the grams of sucrose and fat,
ask them to go into the laboratory and use a canister of sugar and a can of shortening to weigh out the
amount consumed. The visual impact can be startling.

Activity 2-3: Sugar in Soda2

Bring a teaspoon, white sugar, and a glass to class. Ask students how much sugar they put in coffee or
tea. Start putting sugar in the glass and have students tell you when they would stop adding sugar. Add
sugar to the glass until you have put in 8 teaspoons. Ask if they would drink something with that much
sugar. Explain that this is the amount of sugar in one can of soda.

Activity 2-4: Sugar and Fiber Content of Breakfast Cereals

Packages from dry breakfast cereal are easy to keep on hand to illustrate concepts regarding product
labeling regulations and carbohydrates. Show examples of various cereal packages to the class as you talk
about types of sugars on product ingredient lists, types of dietary fiber, marketing concepts and so on. If
the students are doing a nutrition labeling assignment, they will find that breakfast cereal labels make
good illustrations. Ask the students to review the sugar and fiber content of breakfast cereals in their
kitchen cupboards before the next class period or visit a supermarket to look at cereal selection and
labeling. They could call a food company’s toll-free consumer number listed on a cereal package to ask a
question about the product or packaging. Have them calculate the % of total kcalories from carbohydrate
for a cereal product. In class, divide the students into groups that will compile results and evaluate
cereals based on their findings.

Activity 2-5: Diet Analysis

Ask the students to bring their 24-hour dietary record prepared using the “Analysis” activity at end of
Chapter 1. Have them analyze the 24-hour recall to identify carbohydrate foods, and to classify them into
simple sugars, starches, and fibers. Students should identify those high in fiber, and those of higher
nutrient density or rich in “empty-kcalorie” simple sugars.

Activity 2-6: ADA Resources on Carbohydrates

Have the students review the information ADA prepares for the general public on carbohydrate-related
topics. It can be found by navigating to www.eatright.org, clicking on “Food & Nutrition Information,”
then clicking on “Nutrition Fact Sheets.” Ask them to print out an ADA Fact Sheet related to the chapter
and summarize it to prepare for a class discussion on the topic.

1Thanks to Barbara A. Stettler, Bluffton College.

2Source: L. Turner, Instructor's Manual for Understanding Nutrition, Eighth Edition (Belmont, CA: West
Wadsworth, 1999).
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If you have a more advanced class, ask them to review the ADA position papers on carbohydrate-related
topics such as use of nutritive and nonnutritive sweeteners or the health implications of dietary fiber. To
locate the relevant paper, type a keyword such as sweetener into the search section on the main page, or
click on “Position Papers” and browse paper titles.

Activity 2-7: Nutrition Portfolio

Another popular term assignment is a nutrition portfolio or resource file. The students are given a list of
items to include in a resource file or portfolio which each student assembles over a set period of time—
usually the first half of the semester or the whole semester. These would include such items as Internet
page evaluations, dietary evaluations, and resources that will be of use in later courses or in their
professional careers. Usually, the instructor will include an item for each chapter on the list. It might
include the answers to the “Clinical Applications” questions at the end of the chapter. The advantage of
this assignment is that it is relatively easy to mark while keeping students focused on application of the
lecture material. It also provides them with a useful resource file for later use.

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 Worksheet 2-1 –True/False Practice Quiz

Circle the correct answer. If the statement is false, rewrite the statement in a correct
form.

T F 1. Carbohydrates are found in all animal foods.

T F 2. The principle carbohydrate in table sugar is lactose.

T F 3. Carbohydrates should be avoided as they are fattening.

T F 4. The main carbohydrate food in the diet is starch.

T F 5. Glucose is the form in which sugar circulates in the blood.

T F 6. The Dietary Reference Intake (DRI) for carbohydrate is 100 grams per day.

T F 7. Excess dietary carbohydrate is converted into fat in the body.

T F 8. Honey is much superior nutritionally to table sugar.

T F 9. Cellulose is a polysaccharide that is not digested in the small intestine.

T F 10. Sugars pose no major health threat except for an increased risk of dental
caries.

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 Worksheet 2-2

1. The two main categories of simple carbohydrates are:

a. b.

2. The complex carbohydrates (polysaccharides) are:

a. c.
b.

3. The monosaccharides (single sugars) are:

a. c.
b.

4. The disaccharides (double sugars) are:

a. c.
b.

5. The energy-yielding polysaccharides are:

• ______________ (from plants) • _______________(from animal sources)

6. Fibers are classified by their solubility in water into:

a. b.

7. Factors that influence the development of dental caries (by influencing the length of time a cariogenic
food is in the mouth) include:

a. c.
b. d.

8. Names on ingredient lists of food products which you recognize as sugar include:

a. d.
b. e.
c.

9. Sugar alcohols are nutritive sweeteners with _____ kcalories per gram.

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10. Sugars and starches yield _____ kcalories per gram.

11. Alternative, artificial sweeteners which are nonnutritive include:

a. d.
b. e.
c.

12. Insoluble fibers may benefit health by:

a. b.

13. Soluble fibers may benefit health by:

a. c.
b.

14. Food sources of complex carbohydrate (starch and fiber) are:

• Grains Group portion example ___________________________

• Vegetables Group portion example ___________________________
• Fruits Group portion example ___________________________
• Meat & Beans Group portion example ___________________________

15. It is recommended that _____% to _____% of total kcalories should come from carbohydrate
(according to the AMDR) and that no more than 10% of total kcalories from concentrated sugars
(according to the WHO).

16. Food labels must list the amount in grams of the following carbohydrate components:

a. c.
b.

17. The body stores glucose in:

a. b.

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 Worksheet 2-3 –
Food Examples of Nutrients and Other Food Components

Please complete the chart below by listing one good food source for each nutrient, compound or food
element term. Name a food or beverage, not a nutrient or chemical compound. This exercise will test
whether you can apply the material on nutritional biochemistry in a practical way. You may use the same
food as an example as many times as you wish.

Correct and incorrect examples:

Food term, nutrient, compound or food element One good example of a significant food or
beverage source
Simple carbohydrate brown sugar (correct)
Fructose honey (correct)
Fructose sucrose (incorrect: not a food name)

Food term, nutrient, compound or food element One good example of a significant food or
beverage source
monosaccharide

disaccharide

polysaccharide

complex carbohydrate

starch

lactose

sucrose

insoluble fiber

soluble fiber

pectin

lignin

cellulose

sugar alcohol

nonnutritive sweetener

cariogenic food

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