Nutrition for Healthy Living 4th

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CHAPTER 5
CARBOHYDRATES

OVERVIEW

In Chapter 5, students will learn about the different types of carbohydrates, food sources of each, and
the general pathways for their digestion, absorption, and metabolism. Lactose intolerance is discussed.
Students will be introduced to the regulation of blood glucose by the hormones insulin and glucagon
and will learn about health conditions that result from the failure of the body to properly regulate blood
glucose. Various diet patterns are discussed relative to their impact on development of chronic
diseases. In the Nutrition Matters section, the concepts of glycemic index and glycemic load are
explored.

TEACHING STRATEGIES

1. Have students complete the Personal Dietary Analysis activity on page 160. Is their fiber intake
adequate? If their intake is inadequate, students should suggest ways to incorporate high-fiber
foods into their diet.

2. Display amounts of added sugars in commonly-consumed foods, such as those listed in Table 5.3.

3. Ask “Should the government have a special tax on sugary beverages?” Have students discuss
reasons why they would or would not support this idea.

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4. Invite a person with diabetes to class. Encourage students to ask questions concerning the person’s
management of the disease.

5. Instruct students to take the Diabetes Risk Test (www.diabetes.org/risk-test.jsp) and consider their
findings.

6. Provide students with a typical one-day meal plan for a low-carbohydrate diet. Have students
analyze the macronutrient contents of the diet using NutritionCalc Plus. Does the meal plan meet
the AMDR for each macronutrient? When followed regularly, what can be the metabolic effects of
such a diet?

7. Have students determine amount of fiber in a meal comprised of a plain hamburger on white bun,
½ cup of French fries, and 8 ounces of a regular soft drink. Have students suggest ways to increase
the fiber content of this meal.

8. Ask students if they use nonnutritive sweeteners. If they use such products, ask them why.

9. Ask students if they avoid milk because they experience abdominal discomfort after consuming the
beverage. Of those students who may have lactose intolerance, can they consume small amounts of
milk or certain dairy foods without becoming symptomatic?

CHAPTER OUTLINE

I. Introduction
A. Humans prefer foods that taste sweet
1. Sugary taste is a clue that food contains carbohydrates.
B. Carbohydrates: simple and complex
C. Plants use the sun’s energy to combine carbon, oxygen, and hydrogen into sugars, starches,
and fiber.
1. Sun’s energy is stored in the bonds holding carbon and hydrogen atoms together.
2. Human cells break down some of these bonds to yield energy that powers cellular work,
including contracting muscles, making compounds, and building bone tissues.
3. Added caloric sweeteners to the diet are empty calories with little nutritional value
other than carbohydrates.
4. Consuming too much simple sugar can lead to extra body fat.
II. Simple Carbohydrates: Sugars
A. Monosaccharides: simplest type of sugar; one sugar; basic chemical unit of carbohydrates
1. Glucose (dextrose)
a. Dietary sources: fruits and vegetables
b. Primary fuel for body cells, especially red blood cells and nervous system cells
2. Fructose (fruit sugar or levulose)
a. Dietary sources: fruit, honey, and some vegetables
b. Tastes sweeter than sugar
c. High fructose corn syrup is commercially manufactured as a sweetener for foods
and beverages
d. Converted into glucose or fat in the body

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 3. Galactose
a. Dietary source: milk
b. Produced by breastfeeding women
B. Disaccharides: sugar comprised of two monosaccharides
1. Maltose: glucose + glucose (malt sugar)
2. Lactose: glucose + galactose (milk sugar)
3. Sucrose: glucose + fructose (table sugar)
a. Dietary sources
i. Naturally found in honey, maple syrup, carrots, and pineapples
ii. Most sucrose in the food supply is refined from sugar cane and sugar beets.
b. Sucrose and honey are very nutritionally similar.
c. Table 5.2 lists various names for sugars that appear on food labels.
C. Nutritive and nonnutritive sweeteners
1. Functions of sugars in foods
a. Flavor
b. Browning
c. Preservative
d. Nutritive sweetener: contributes 4 kcal/g to foods
2. Added sugars: not naturally present; added to foods during preparation or processing
3. Alternative sweeteners (sugar replacers, sugar substitutes, artificial sweeteners)
a. Sweetens foods while providing few or no kcal
b. Alternative nutritive sweeteners (sugar alcohols)
i. Examples: xylitol, mannitol, and sorbitol
ii. Not well absorbed; contribute only 2 kcal/g
iii. May cause diarrhea when consumed in large quantities.
c. Nonnutritive sweeteners
i. Synthetic compounds that taste intensely sweet but do not contribute calories
ii. Help with control of calorie intake
iii. Do not promote tooth decay
iv. Sugar free ≠ calorie free
v. Studies suggest that artificially sweetened foods may promote excess caloric
intake.
a) More research is needed.
b) Taste of artificially sweetened foods may interfere with regulating intake of
sugary foods.
vi. Despite controversy, current evidence does not indicate health risks from
consuming alternative sweeteners.
vii. Examples
a) Saccharin
1) In use over 100 years
2) Safety questioned
3) Scientific evidence indicates safe when consumed in typical amounts
b) Aspartame
1) Contains phenylalanine, an amino acid of concern for people with
phenylketonuria, an inherited disorder that results in abnormal
phenylalanine metabolism.

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 2) Has been under intense scrutiny for purported links to a variety of
health concerns, but no scientifically sound studies support the claims
c) Acesulfame-K
d) Sucralose
1) Made from sugar that is chemically modified so that it cannot be
digested
2) Resists destruction by heat, so it may be used in cooking.
e) Neotame
f) Stevia extracts
1) Rebiana is chemical in stevia that is responsible for its sweetness.
2) FDA considers rebiana safe for use as an all-purpose sweetener.
viii. According to the Academy of Nutrition and Dietetics (formerly American
Dietetic Association), artificial sweeteners are safe when consumed within
acceptable daily intakes, even during pregnancy.
ix. Table 5.5 lists Acceptable Daily Intakes of Nonnutrive Sweeteners.
III. Complex Carbohydrates
A. Introduction
1. Polysaccharides contain 10 or more monosaccharides
2. Storage of energy
3. Structure (e.g., stems and leaves)
4. Digestibility varies
B. Starch and glycogen
1. Polysaccharides that contain hundreds of glucose molecules bound together in chains
2. Starch
a. Form of glucose storage for plants
b. Dietary sources
i. Bread and cereal products
ii. Some vegetables (e.g., corn, peas)
iii. Beans
iv. Tubers (e.g., potatoes, yams)
v. Modified starches are used in some food products
3. Glycogen
a. Form of glucose storage in animal and human muscle and liver tissues
b. Glycogen breaks down after an animal dies, so meats are not a source of
carbohydrate.
C. Fiber
1. Plants use complex carbohydrates to make supportive structures and protective
coatings.
2. Polysaccharides that contain glucose molecules joined by bonds that humans cannot
digest.
3. Two types of fiber (summarized in Table 5.6)
a. Soluble fiber
i. Examples
a) Pectin
b) Gums
ii. Dissolve and swell in water
iii. Dietary sources

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 a) Oat bran and oatmeal
b) Beans
c) Apples
d) Carrots
e) Oranges and other citrus fruits
f) Psyllium seeds
iv. Physiological effects
a) Delays gastric emptying
b) Slows glucose absorption
c) Lowers blood cholesterol
b. Insoluble fiber
i. Examples
a) Cellulose
b) Lignin
ii. Do not dissolve in water
iii. Dietary sources
a) Whole grain products
1) Made from intact, ground, cracked, or flaked seeds of cereal grains
2) Contain endosperm, germ, and bran
b) Vegetables
iv. Physiological effects
a) Increases fecal bulk
b) Speeds fecal transit through GI tract
4. Food sources of fiber are listed in Table 5.7.
IV. What Happens to Carbohydrates In Your Body?
A. Pathway for carbohydrates (Fig 5.7)
1. Mouth: some starch is broken down by salivary amylase.
2. Stomach: acid stops amylase activity
3. Small intestine:
a. Majority of starch is broken down by pancreatic amylase into di- and
monosaccharides.
b. Disaccharides are broken down into monosaccharides by maltase, sucrase, or
lactase.
c. Monosaccharides are absorbed by intestinal cells into the bloodstream.
d. Very little starch escapes digestion.
4. Bloodstream: monosaccharides are transported via the portal vein to the liver.
5. Liver
a. Converts fructose, galactose, and some glucose to glycogen or fat, which can be
broken down later for energy.
b. Some glucose remains in the bloodstream to supply energy for body cells.
6. Large intestine
a. Some soluble fiber is fermented by intestinal bacteria.
b. Insoluble fiber adds to fecal bulk.
c. Cells of the large intestine derive some energy from bacterial fermentation
products.
d. Average American consumes 16 g of fiber daily.
B. Maintaining blood glucose levels

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 1. Glucose is an important cellular fuel.
a. Blood glucose level is carefully maintained by insulin and glucagon.
b. Combined effects of insulin and glucagon regulate blood glucose level between 70 –
100 mg/dl in healthy humans.
c. Fig 5.8 illustrates the effects of insulin and glucagon on blood glucose levels.
2. Insulin
a. Produced by beta cells of pancreas
b. Enables glucose to enter body cells, thereby lowering the amount of glucose in the
blood
c. Enhances energy storage by promoting production of fat, glycogen, and protein
d. Contributes to satiety after eating a meal
3. Glucagon
a. Produced by alpha cells of pancreas
b. Promotes glycogenolysis, the breakdown to glycogen to release glucose into the
blood
c. Stimulates production of glucose from amino acids by cells in the liver and kidney
d. Stimulates lipolysis, the breakdown of triglycerides into glycerol and fatty acids for
energy
e. Liver uses glycerol to produce glucose
f. Body cannot use fatty acids to make glucose
4. The fate of glucose depends on the body’s state.
a. In a fed or resting state, glucose is likely to be stored as glycogen or fat.
b. In a fasted or exercising state, glucose is likely to be metabolized for energy.
C. Glucose for energy
1. Glucose is the primary fuel for body cells, especially red blood cells and nervous tissue.
2. Cells break down glucose into water and carbon dioxide to release the energy stored in
its chemical bonds.
3. Glucose is necessary for proper metabolism of fat:
a. With poorly controlled diabetes, fasting, starving, or very low-carbohydrate diet,
cells must use greater amounts of fat for energy.
b. Ketones are chemical byproducts of incomplete fat metabolism, as occurs in the
absence of adequate glucose.
c. Muscles and brain cells can use ketones for energy.
d. Ketosis results from the accumulation of ketones in the blood; excess cause blood to
become acidic ketoacidosis, which can be dangerous or life-threatening.
e. RDA for carbohydrates is 130 g/d to prevent ketosis.
4. Cells may convert amino acids to glucose to be used for energy.
a. Under normal conditions, amino acids are used for fuel only to a minor extent.
b. Under conditions of starvation, amino acids are depleted from muscles and organs
to provide energy for vital processes, leading to weakness, wasting, and eventually,
death.
V. Carbohydrate Consumption Patterns
A. In developing nations, unrefined carbohydrates provide 70% or more of total calories.
B. Typical American diets supply about 50% of calories from carbohydrates.
C. AMDR: 45% – 65% of total calories as carbohydrates
D. Added sugars
1. According to MyPlate, added sugars are grouped with solid fats as empty calories.

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 2. USDA 2000 kcal dietary plan limits added sugar to 8 teaspoons per day.
3. Typical American diets supply 22 tsp/d of added sugars.
4. Regular soft drinks are the primary source of added sugars.
5. Although they provide about the same amount of sugar as soft drinks, 100% fruit juices
also supply vitamins, minerals, and phytochemicals.
6. MyPlate recommends that adults consume 1 ½ to 2 cups of fruit or fruit equivalents
each day.
E. Reducing your intake of refined carbohydrates
1. Refined grain products and foods with added sugars may crowd out more nutritious
foods.
2. Convenience foods typically supply lots of refined carbohydrates; plan ahead to pack
nutritious foods rather than relying on convenience foods.
3. Choose yogurt, fresh fruit, and low-fat dairy products instead of regular soft drinks and
other processed foods.
4. Keep fruit handy for snacks and dessert.
5. Most fruits offer antioxidants; they have less fat and more fiber, vitamins, and minerals.
VI. Understanding nutrient labeling: carbohydrates and fiber
1. Total carbohydrate
2. Dietary fiber (some product labels may distinguish between soluble and insoluble fibers)
3. Sugars: label does not distinguish between naturally-occurring and added sugars
4. Subtract fiber and sugars from total carbohydrate to find grams of starch.
5. Look at ingredients to identify sources of sugar.
VII. Carbohydrates and Health
A. Introduction
1. Carbohydrates get a lot of bad press: blamed for unwanted weight gain and diabetes
2. Welcomed by athletes as inexpensive efficient source of energy
B. Are carbohydrates fattening?
1. Overall balance of energy consumed and energy expended determines weight change,
regardless of source of calories.
2. Refined carbohydrates tend to be less satisfying, which may lead to overeating.
3. Carbohydrate-restricted diets help to control hunger in the short term, but long-term
compliance is poor.
4. High carbohydrate diets can result in weight loss if the sources of carbohydrates are rich
in fiber and unrefined starches, because fiber increases satiety.
5. Starches and sugars are often combined with hidden fats, which add excess calories,
thus contributing to weight gain.
6. Overconsumption of foods rich in high fructose corn syrup (e.g., regular soft drinks) is
linked to obesity.
a. People consuming many calories from beverages do not adjust their calorie intake
from solid foods to compensate for the excess calories.
b. Overconsumption of calories leads to weight gain, which also contributes to risk for
chronic health conditions.
7. Combining carbohydrate with fat
a. Foods containing a lot of added sugar and fat tend to be energy dense.
b. Carbohydrates are blamed for unwanted weight gain because starches and sugars
are combined with hidden fats (butter, oil, shortening-- a solid fat) in processed
foods.

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 8. Sugar-sweetened soft drinks and body weight
a. Some nutrition scientists think that American’s love for foods and beverages
sweetened with high fructose corn syrup (HFCS) is responsible for rising obesity
rate.
b. Rising prevalence of childhood obesity is a major public health concern.
c. Some schools ban empty-calorie foods from school cafeterias and vending
machines.
d. Studies indicate that regular soft drink consumption is not balanced with a
reduction in energy from solid foods, contributing to weight gain, which may
increase the risk of type 2 diabetes.
e. Excess caloric intake from all foods also increases the prevalence of obesity.
9. Tooth decay
a. Carbohydrates, especially sticky simple sugars, provide food for bacteria that live on
the teeth.
b. Bacteria produce acids that break down tooth enamel.
C. What is diabetes?
1. Diabetes mellitus is a group of chronic diseases characterized by abnormal glucose, fat,
and protein metabolism.
a. Normal fasting blood glucose: 70-99 mg/dl
2. Hyperglycemia (fasting blood glucose ≥ 126 mg/dl)
a. May result from insufficient production of insulin
b. May result from insensitivity of body’s cells to insulin
3. Signs and symptoms (Table 5.9)
a. Excessive thirst
b. Frequent urination
c. Blurred vision
d. Poor wound healing
4. Long-term complications
a. Nerve damage, leading to limb amputations
b. Organ damage, leading to kidney disease and heart disease
c. Blood vessel damage, leading to heart disease and blindness
d. Death
5. Prevalence of diabetes is increasing at an alarming rate among all age groups.
a. Prevalence increases with age.
b. Public health concern about increasing diabetes among children and adolescents
c. Many cases are undiagnosed.
6. Classification
a. Pre-diabetes (impaired glucose tolerance)
i. Fasting blood glucose 100 – 125 mg/dl
ii. At risk of cardiovascular disease and eventually developing type 2 diabetes
b. Type 1 diabetes
i. 5% – 10% of all cases of diabetes
ii. Formerly termed “juvenile diabetes” due to typical age of diagnosis, although it
can strike at any age.
iii. Usually an autoimmune disease, with both genetic and environmental
influences (e.g., viral infections during childhood).

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 iv. Pancreatic beta cells are damaged and do not produce enough insulin to
regulate blood glucose.
v. Undiagnosed or poorly controlled blood glucose may develop ketoacidosis
a) Signs and symptoms of ketoacidosis
1) Excessive thirst
2) Frequent urination
3) Blood glucose > 250 mg/dl
4) Nausea and vomiting
5) Fatigue
6) Confusion
7) “Fruity” or acetone breath
b) Untreated ketoacidosis can lead to coma and death.
vi. Proper management includes regular blood glucose testing.
vii. At present, there is no cure for type 1 diabetes.
c. Type 2 diabetes
i. Majority of all cases of diabetes
ii. Formerly termed “adult onset diabetes,” but can also occur in children and
adolescents.
iii. Beta cells of pancreas usually produce adequate insulin in early stages of type 2
diabetes, but body cells are insulin-resistant.
iv. Over time, beta cells may lose function.
v. Risk factors
a) Sedentary
b) Overweight or obese
c) Family history of type 2 diabetes
d) Hispanic, Native American, Asian, African, or Pacific Islander ancestry
e) History of gestational diabetes
f) American Diabetes Association online questionnaire to assess risk of type 2
diabetes http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/
d. Diabetes during pregnancy
i. Healthy pregnancy typically lasts about 40 weeks.
ii. First 8 weeks of pregnancy are a critical period in human embryo’s
development.
iii. Proper blood glucose management
a) Reduces the risk of delivering a baby with birth defects
b) Fewer health problems, such as high blood pressure, during pregnancy
iv. Gestational diabetes
a) Develop in about 10% of American women after 5th month of pregnancy.
b) Increased risk for gestational diabetes:
1) Family history of type 2 diabetes
2) Overweight
3) Have high blood pressure
c) Fetus receiving too much glucose from hyperglycemic mother gains weight
rapidly.
1) Abnormally heavy at birth, weighing 9 pounds or more
2) Delivering large baby is risky for both mother and infant.
a. Prolonged birth process

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 b. Injury to infant during delivery
d) Most mothers recover and have normal blood glucose levels, but are at risk
of developing type 2 diabetes later.
e) Poorly controlled diabetes or gestational diabetes have more miscarriages,
stillbirths, premature deliveries, and infants who have difficulty controlling
their own blood glucose.
1) Careful monitoring of blood glucose levels minimizes risks to mothers
and their fetuses.
2) Prenatal medical care includes screening for gestational diabetes.
3) Treatment for gestational diabetes includes special diet and regular
physical activity; some need to monitor blood glucose and take insulin.
7. Controlling diabetes
a. To avoid or delay complications of hyperglycemia, blood sugar must be controlled.
b. Self monitoring of blood glucose and glycosylated hemoglobin (aim for <7%)
c. Diet therapy involves counting grams of carbohydrates eaten.
d. Physical activity increases insulin sensitivity.
e. Moderate weight loss improves insulin sensitivity.
f. Oral medications and/or insulin injections
8. Can diabetes be prevented?
a. No way to prevent type 1 diabetes.
b. Risk of type 2 diabetes is reduced by therapeutic lifestyle changes (TLC):
i. Avoiding excess body fat
ii. Exercising daily
iii. Dietary changes
c. Dietary habits associated with increased risk of diabetes:
i. “Western diet,” which contains high amounts of red meat, processed meats,
fried foods, high-fat dairy products, refined sugars, and starches.
ii. Medical experts are concerned that excess sugar, particularly fructose, may
increase risk for type 2 diabetes.
d. Dietary habits associated with decreased risk of diabetes:
i. Prudent diet, which contains more poultry, fish, fiber-rich whole grains, fruits,
and vegetables than Western diet
D. What is hypoglycemia?
1. Blood glucose levels are too low to provide sufficient energy for cells (fasting blood
glucose <70 mg/dl).
2. Symptoms (related to release of epinephrine [commonly called adrenaline] to increase
the supply of glucose and fats in the bloodstream):
a. Irritability
b. Restlessness
c. Shakiness
d. Sweating
e. Loss of consciousness or death may result when blood glucose drops too low.
3. Despite popular hype, hypoglycemia is a rare condition.
4. This serious disorder can affect people with type 1 diabetes who receive too much
insulin and those with certain tumors of the pancreas.
5. Reactive hypoglycemia

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 a. May occur after ingestion of highly refined carbohydrates because the pancreas
oversecretes insulin, which causes blood sugar levels to decline rapidly after eating.
b. Dietary therapy for reactive hypoglycemia:
i. Avoidance of highly refined carbohydrates
ii. Eating smaller, more frequent meals that contain a mixture of macronutrients
E. Metabolic syndrome
1. A group of signs and symptoms that increases risk of type 2 diabetes (summarized in
Table 5.11); characterized by the presence of three or more of the following signs:
a. Large waist circumference
b. Hypertension
c. High triglycerides
d. Low HDL cholesterol
e. High fasting blood glucose
2. Elevates risk for chronic diseases
a. Increases risk of developing type 2 diabetes fivefold
b. Increases risk of developing cardiovascular disease twofold
3. Risk factors for development of metabolic syndrome
a. Genetics
b. Excess abdominal fat
c. Insulin resistance
d. Poor diet
e. Inactivity
f. Cigarette smoking
4. Prevention of metabolic syndrome
a. Exercise regularly
b. Increase intake of fruits, vegetables, and whole grains
5. Treatment of existing metabolic syndrome
a. Control elevated glucose, insulin, and triglycerides
b. Lose excess weight
c. Exercise regularly
d. Reduce intakes of salt, saturated fat, cholesterol, and simple sugars
e. Medications
F. Lactose intolerance (lactose maldigestion or malabsorption)
1. Millions of Americans suffer from lactose intolerance.
2. Intolerance ≠ allergy
3. Insufficient production of lactase enzyme; undigested lactose reaches large intestine
where it is fermented by bacteria to produce gases and acids, which lead to cramping,
bloating, gas, and/or diarrhea.
4. Some degree of lactose intolerance is normal after infancy, particularly among people of
African, Asian, and Eastern European ancestry.
5. Dietary advice to achieve nutritional adequacy without discomfort of lactose
intolerance:
a. Yogurt
b. Hard cheeses (e.g., cheddar, Swiss)
c. Small amounts of milk
d. Use of lactase additives (e.g., Lactaid)
e. Substitute soy milk for cow’s milk

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 G. Does sugar cause hyperactivity?
1. Attention deficit hyperactivity disorder is characterized by impulsivity, difficulty paying
attention, difficulty controlling behavior
2. Causes of ADHD involve genetic and environmental influences
3. Scientific evidence does not relate sugar consumption to behavioral problems
4. It is more likely that the circumstances in which sugar is consumed (e.g., parties) lead to
overstimulation.
H. Fiber and health
1. Fiber is not an essential nutrient because body can live without it, but fiber has
numerous health benefits:
a. Reduce risk of obesity, diabetes, certain intestinal tract disorders, and
cardiovascular disease
2. Fiber and the digestive tract
a. Constipation increases risk for hemorrhoids and diverticula
b. Increasing the fiber content of the diet promotes larger, softer, more frequent
bowel movements.
c. Results of several recent epidemiological studies do not indicate that high-fiber
diets decrease risk of colorectal cancer.
3. Fiber and heart health
a. Diets rich in fiber, particularly soluble fiber, can reduce the risk of cardiovascular
disease by reducing blood cholesterol.
b. Soluble fiber (e.g., in oats) reduces the reabsorption of cholesterol components of
bile so that they are eliminated with bowel movements, thus requiring the liver to
pull cholesterol from the blood to make new bile.
c. Health claims relating soluble fiber intake to reduced risk of cardiovascular disease
are permitted on food packages.
4. Fiber and weight control
a. High-fiber diets promote satiety, discourage overeating.
b. High-fiber foods have low energy density.
5. Increasing your fiber intake
a. AIs for fiber are 25 g/d for women or 38 g/d for men.
b. Typical American diets supply 16 g/d.
c. Excessive fiber intake has negative consequences:
i. Intestinal gas
ii. Interferes with absorption of minerals
iii. Intestinal blockage, particularly in combination with low fluid intake
d. To avoid excess intestinal gas, increase fiber intake gradually
e. See Food & Nutrition Tips on page 155 for dietary tips to increase fiber intake.
VIII. Nutrition Matters – Glycemic Index and Glycemic Load
A. Foods that contain large amounts of refined carbohydrates are digested rapidly and cause a
rapid rise in blood glucose, followed by a sharp increase in insulin levels.
B. Sources of carbohydrates with high fiber contents are digested slowly and cause less
dramatic rises in blood glucose and insulin.
C. Glycemic index (GI) classifies carbohydrate-rich foods based on the rise in blood glucose
observed after consuming a portion of a food that contains 50 g of digestible carbohydrate;
this response is expressed as a percentage of the rise in blood glucose observed after

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 consuming a portion of a standard food (white bread or glucose) that contains 50 g of
carbohydrate.
1. High ≥ 70
2. Moderate or low < 70
D. Glycemic load (GL) is a more realistic way of rating foods based on their effects on blood
glucose and insulin; to find glycemic load, multiply the food’s GI by the grams of
carbohydrate in a typical portion of that food, then divide by 100.
1. High > 20
2. Low < 15
E. The GIs and GLs of some carbohydrate-rich foods are presented in Table 5.12.
F. Criticisms of GI and GL
1. GI varies widely for a particular food based on the location it was grown, the degree of
ripeness, extent of processing, etc.
2. Measurement of GIs may vary between individuals.
3. GI values reflect the blood glucose impact of a single food, whereas foods are consumed
as part of a mixed diet.
G. Research on GI and GL
1. Epidemiological studies suggest an association between high GI/GL diets and serious
chronic diseases (e.g., obesity, type 2 diabetes, cardiovascular disease, and some types
of cancer).
2. Low GI diets may improve blood lipid levels and reduce the risk of cardiovascular
disease.
3. People with diabetes can follow a low GI/GL diet while monitoring their total
carbohydrate intake to control their blood glucose levels and improve HbA1c levels.
H. More long-term research is needed before health experts can recommend low GI/GL diets
for the general population.

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