SYSTEMS PLUS COLLEGE FOUNDATION

Angeles City
COLLEGE OF NURSING

Nursing Care Management 105: NUTRITION AND DIET THERAPY

1st Semester, S.Y. 2024-2025

HANDOUT No. 4: CARBOHYDRATES (CHO)

I. LEARNING OUTCOMES

At the end of this lecture, the students should be able to:

1. Identify the functions of carbohydrates

2. Name the primary sources of carbohydrates
3. Describe the classification of carbohydrates
4. Explain how hormones control blood glucose concentrations.
5. Recognize the deficiencies and toxicities asscociated with carbohydates

II. CONTENT

INTRODUCTION:

Energy foods are those that can be rapidly oxidized by the body to release energy and its by-product,
heat. Carbohydrates, one of the energy-yielding nutrients will always be the primary source of energy for
the body.

CARBOHYDRATES

→ Is the preferred energy source for many of the body’s functions.

→ Provide the major source of energy for people all over the world.
→ They are the least expensive and most abundant of the energy nutrients. Foods rich in
carbohydrates grow easily in most climates. They keep well and are generally easy to digest.
→ As long as carbohydrate is available, the human brain depends exclusively on it as an energy
source.
→ Carbohydrates are named for the chemical elements they are composed of—carbon (C),
hydrogen (H), and oxygen (O).

� FUNCTIONS

1. Provides energy

→ Is the major function of carbohydrates. Each gram of carbohydrate provides 4 calories.

The body needs to maintain a constant supply of energy. Therefore, it stores
approximately half a day’s supply of carbohydrate in the liver and muscles for use as
needed. In this form, it is called glycogen.

2. It has protein-sparing action

→ Is also an important function of carbohydrates. When enough carbohydrates (at least

50–100 g/day) are ingested to supply a person’s energy needs, they spare proteins for
their primary function of building and repairing body tissues.

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 3. Maintain normal fat metabolism

→ If there are not enough carbohydrates to fulfill the energy requirement, an abnormally
large amount of fat is metabolized to help meet it.
→ During such an emergency need for energy, fat oxidization in the cells is not complete
and substances called ketones are produced.
● Ketones are acids that accumulate in the blood and urine, upsetting the acid-
base balance. Such a condition is called “ketoacidosis”.
● Ketoacidosis can result from IDDM (insulin-dependent diabetes mellitus),
also known as type 1 diabetes, from starvation, or from extreme low-
carbohydrate diets. It can lead to coma and even death.

Incomplete fat catabolism lead to the formation of ketone bodies (metabolic acidosis)

4. It has antiketogenic effect

→ When enough carbohydrates are eaten, the body is protected against ketones.

5. Provides fiber

→ Is another important function of carbohydrates. Dietary fiber is found in grains,

vegetables, and fruits.
→ Fiber - indigestible parts of plants; absorbs water in large intestine, helping to create
soft, bulky stool that moves quickly through the large intestine; some is believed to
bind cholesterol in the colon, helping to rid cholesterol from the body; some is believed
to lower blood glucose levels.

� CLASSIFICATIONS

→ Carbohydrates are divided into three groups: monosaccharides, disaccharides, and

polysaccharides:

♦ MONOSACCHARIDES

→ single sugars units; mono = one; saccharide = sugar

→ are the simplest form of carbohydrates.
→ They are sweet, require no digestion, and can be absorbed directly into the
bloodstream from the small intestine.

→ Three kinds of Monosaccharides: glucose, fructose, and galactose.

a. Glucose
─ Also called dextrose; blood sugar; is the form of carbohydrate to
which all other forms are converted for eventual metabolism.
─ It is found naturally in corn syrup and some fruits and vegetables.
─ The central nervous system, the red blood cells, and the brain use
only glucose as fuel; therefore, a continuous source is needed.
─ To function optimally, the body must maintain blood glucose within
limits that allow the cells to nourish themselves.

b. Fructose –
─ Also called levulose or fruit sugar.
─ It is the sweetest of all the sugars.
─ It is found in many fruits and in honey, and as part of table sugar.

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 c. Galactose
─ Is a product of the digestion of milk. It is not found naturally.
─ Occurs mostly as part of lactose, a disaccharide also known as milk
sugar.
─ During digestion, galactose is freed as a single sugar.

♦ DISACCHARIDES

→ Double sugars; pairs of single sugars that are linked together; di = two;
saccharide = sugar

→ Three kinds of Disaccharides are: sucrose, maltose and lactose.

a. Sucrose
─ Is composed of glucose and fructose.
─ Known as table or white sugar, beet sugar, and cane sugar
─ is the most familiar of the three disaccharides and is what people
mean when they speak of “sugar.”
─ It is the form of carbohydrate present in granulated, powdered, and
brown sugar and in molasses.
─ It is one of the sweetest and least expensive sugars.
─ Its sources are sugar cane, sugar beets, and the sap from maple
trees.

b. Maltose
─ Commonly known as malt sugar
─ is a plant sugar that consists of two glucose units (glucose + glucose)
─ Maltose is produced whenever starch breaks down (digestion of grain)
─ It also is created during the fermentation process that produces
alcohol.
─ It is considerably less sweet than glucose or sucrose.
─ It can be found in some infant formulas, malt beverage products, and
beer.

c. Lactose
─ Composed of two monosaccharide parts: (glucose + galactose)
─ commonly known as milk sugar
─ Is the sugar found in milk and milk products; It is distinct from most
other sugars because it is not found in plants.
─ It helps the body absorb calcium.
─ It is less sweet than monosaccharides or other disaccharides.

─ Note: Many adults are unable to digest lactose and suffer from
bloating, abdominal cramps, and diarrhea after drinking milk or
consuming a milk-based food such as processed cheese. This
reaction is called Lactose Intolerance. It is caused by insufficient
“lactase”, the enzyme required for digestion of lactose.

● There are special low-lactose milk products that can be used

instead of regular milk. Lactase-containing products are also
available.

♦ POLYSACCHARIDES

→ Are commonly called complex carbohydrates because they are compounds of

many monosaccharides (simple sugars).
→ Three kinds of polysaccharides are: starch, glycogen, and fiber.

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a. Starch
─ It is the storage form of glucose in plants.
─ Are more complex than monosaccharides or disaccharides, and it takes
the body longer to digest them. As a result, they supply energy over a
longer period of time.
─ Found in grains such as rice or wheat, in root crops and tubers such as
yams and potatoes, and in legumes such as peas and beans.

Dextrin - formed from partial hydrolysis of starch, found in toasted bread

[action of dry heat].

b. Glycogen
─ Is sometimes called “animal starch” because it is the storage form of
glucose in the body.
─ In adult, approximately one-half day’s supply of energy is stored as
glycogen in the liver and muscles. The hormone “glucagon” helps the
liver convert glycogen to glucose as needed for energy.
─ Is found in meats only to a limited extent and not at all in plants.* For this
reason, glycogen is not a significant food source of carbohydrate, but it
does play an important role in the body.

Note: Excess glucose is stored as glycogen.

GLYCOGENESIS is the conversion of glucose to glycogen.

c. Fiber
─ Dietary fiber, also called “roughage”, is indigestible because it cannot be
broken down by digestive enzymes.
─ Are found in all plant-derived foods—vegetables, fruits, whole grains, and
legumes.

o Two Types:

❖ Insoluble fiber (it does not readily dissolve in water)

→ Do not form gels (are not viscous), and are less readily
fermented.
→ Types of Insoluble fibers:
✔ Cellulose is the main constituent of plant cell walls. It
is found in the skins of fruits, the leaves and stems of
vegetables, and legumes.
✔ Hemicellulose is the main constituent of cereal
fibers; found mostly in whole-grain cereals
✔ Lignins are the tough, woody parts of plants; few
foods people eat contain much lignin; found in
carrots, asparagus and seeds of strawberries.

→ Are found in the outer layers of whole grains (bran), the

strings of celery, the hulls of seeds, and the skins of corn
kernels.
→ These fibers retain their structure and rough texture even
after hours of cooking.
→ In the body, they aid the digestive system by easing
elimination.

❖ Soluble fiber (it partially dissolves in water).

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 → These form gels (are viscous) and are more readily digested
by bacteria in the human large intestine (are easily
fermented).
→ These fibers are often associated with lower risks of chronic
diseases.
→ Provide bulk in the intestines, are useful also because they
bind cholesterol, thus reducing the amount the blood can
absorb.
→ Commonly found in barley, legumes, fruits, oats, and
vegetables.
→ Kinds of soluble fiber: Gums, pectin and mucilages
✔ Pectins are abundant in vegetables and fruits,
especially citrus fruits and apples; use to thicken
jelly and keep salad dressing from separating.

✔ Gums and mucilages have similar structures

and are used as additives or stabilizers by the
food industry.

♦ ALTERNATIVE SWEETENERS
→ Minimal or zero kcal
→ Many times sweeter than sugar (use a little)
→ Non-carcinogenic
→ don’t promote tooth decay

A. SUGAR ALCOHOLS
→ The sugar alcohols are carbohydrates, but they trigger a lower glycemic
response and yield slightly less energy (2 to 3 kcalories per gram) than
sucrose (4 kcalories per gram) because they are not absorbed completely.

→ sugarlike compounds in the chemical family alcohol derived from fruits or

manufactured from carbohydrates; sugar alcohols are absorbed more slowly
than other sugars, are metabolized differently, and do not elevate the risk of
dental caries.
→ are sometimes called nutritive sweeteners because they do yield some
energy.

→ Examples are: Maltitol, Mannitol, Sorbitol, Isomalt, Lactitol, and Xylitol.

→ Note: One exception, erythritol, cannot be metabolized by human enzymes
and so is kcalorie free.

B. NONNUTRITIVE SWEETENERS

→ The nonnutritive sweeteners sweeten with minimal or no carbohydrate or

energy. The human taste buds perceive many of them as extremely sweet, so
just tiny amounts are added to foods to achieve the desired sweet taste.
→ Like sugar alcohols, they do not promote tooth decay.
→ Examples are: Aspartame (NutraSweet), Saccharin (SugarTwin),
Sucralose (Splenda), Stevia

� FOOD SOURCES

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 → The principal s The principal sources of carbohydrates are plant foods:
cereal g vegetables, fruits, and sugars.

� CARBOHYDRATES IN THE DIET

▪ High Sugar Intake

✔ Low nutrient content

✔ Contributes to tooth decay

✔ If excess kcal, contributes to obesity

▪ High Fiber Intake

✔ Better control of blood glucose

✔ Possible reduced cancer risk

✔ Reduced risk of heart disease

✔ Healthier gastrointestinal functioning

� RECOMMENDED DAILY ALLOWANCE FOR CARBOHYDRATES

─ 45 to 65 % of the energy requirement.

─ A person consuming 2000 kcalories must obtain 900 to 1300 kcalories’ worth of
carbohydrate, or between 225 and 325 grams.
─ This amount is more than adequate to meet the RDA for carbohydrate, which is set at 130
grams per day based on the average minimum amount of glucose used by the brain.
─ 14 grams of fiber per 1000 kcalories —roughly 25 to 35 grams of dietary fiber daily

� CARBOHYDRATES AND HEALTH IMPLICATIONS (DEFICIENCY/TOXICITY)

♦ REGULATION OF BLOOD GLUCOSE

Diabetes Mellitus – is a metabolic disorders characterized by elevated blood glucose

resulting from insufficient insulin, ineffective insulin, or both. Left untreated,
fluctuations to the extremes—either high or low—can be fatal. Blood glucose
homeostasis is regulated primarily by two hormones: insulin, secreted by beta cells of
pacreas, moves glucose from the blood into the cells, and glucagon,a hormone
secreted by the alpha cells of the pancreas, brings glucose out of storage when blood
glucose falls (as occurs between meals).

Types:
1. Type 1: IDDM (Insulin Dependent Diabetes Mellitus) – treat with insulin
2. Type 2: NIDDM (Non-insulin Dependent Diabetes Mellitus) – cells are resistant
to insulin
✔ Treat with diet and exercise

✔ May treat with oral medications

✔ May treat with insulin

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 Insulin – a hormone secreted by the beta cells of the pancreas, maintains normal
blood glucose level to 70–110 mg/dl. When the secretion of insulin is impaired or
absent, two conditions occur:

✔ Hyperglycemia - excessive amounts of glucose in the blood (blood glucose

more than 126 mg/dl) and is usually a symptom of diabetes mellitus.

✔ Hypoglycemia – when blood glucose is unusually low (blood glucose less

than 70 mg/dl). A mild form of hypoglycemia may occur if one waits too long
between meals, or if the pancreas secretes too much insulin. Symptoms
include fatigue, shaking, sweating, and headache.

Note:
→ Insulin stimulates cells to take up glucose from the blood lowering blood glucose.

→ Glucagon stimulates liver cells to breakdown glycogen to glucose

(GLYCOGENOLYSIS)
→ Glucagon stimulates liver cells to produce glucose from fat and protein
(GLUCONEOGENESIS)

♦ KETOACIDOSIS

─ Is a condition caused by severe deficiency in carbohydrates; a stage in

metabolism occurring when the liver has been depleted of stored glycogen and
switches to a fasting mode. At this point, energy from fat is mobilized to the liver
and used to synthesize glucose. The by-products of fat breakdown are ketones
that build up in the bloodstream and are then released through the kidneys.

♦ OBESITY

─ Is caused by excessive intake o carbohydrates.

─ Although surplus carbohydrates are changed to glycogen, the major part of any
surplus becomes adipose tissue.

♦ HEART DISEASES (CARDIOVASCULAR DISORDERS)

─ According to research, people with higher intakes of added sugars had blood lipid
values indicating an increased risk of heart disease.
─ In a research study conducted among young adults, those who consumed more
sugar-sweetened beverages had greater abdominal fatness, more harmful blood
lipids, and higher blood pressure than those who drank fewer.

♦ DIVERTICULOSIS

─ A condition characterized by small pouches that bulge outward through the colon,
or large intestine.
─ Fiber helps prevent diverticular disease by softening and increasing the size of the
stool.

♦ CANCER

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 ─ Fiber prevents some colon cancers by moving waste materials through the colon
faster than usual, thus reducing the colon’s exposure time to potential
carcinogens.

♦ OTHERS:
▪ Too many carbohydrates may cause tooth decay, irritate the lining of the
stomach, or cause flatulence.
▪ Despite fiber’s benefits to health, when too much fiber is consumed, some
minerals may bind to it and be excreted with it, without becoming available for the
body to use.

III. KEY POINTS FOR REVIEW

● Carbohydrate is the body’s preferred energy source. Six 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 their bonds cannot be
broken by human digestive enzymes, so they yield little, if any, energy.
● Blood glucose concentrations are regulated primarily by two hormones: insulin, which moves
glucose from the blood into the cells, and glucagon, which brings glucose out of storage when
blood glucose falls.
● Excessive sugar intakes may displace needed nutrients may contribute to obesity.

● Sugar alcohols and non-nutritive sweeteners do not contribute to dental caries.

● 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.

IV. TEST YOUR KNOWLEDGE

1. Polysaccharides include:
A. galactose, starch, and glycogen
B. starch, glycogen, and fiber
C. lactose, maltose, and glycogen
D. sucrose, fructose, and glucose

2. The chief energy source of the body is:

A. sucrose
B. starch
C. glucose
D. fructose

3. The primary form of stored glucose in animals is:

A. glycogen
B. cellulose
C. starch
D. lactose

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 4. The polysaccharide that helps form the cell walls of plants is:
A. cellulose
B. starch
C. glycogen
D. lactose

5. The DRI fiber recommendation is:

A. 10 grams per 1000 kcalories
B. 15 to 25 grams per day
C. 14 grams per 1000 kcalories
D. 40 to 55 grams per day

V. READINGS AND REFERENCES

Dudek, S. G. (2022). Nutrition Essentials for Nursing Practice (9th International Edition).
Philadelphia [etc.]: Wolters Kluwer.

Duyff, R. L. (2017). Academy of Nutrition and Dietetics Complete Food and Nutrition Guide (5th
Edition). Boston ; New York: Houghton Mifflin Harcourt.

Grodner, M. & Escott-Stump, S. (2023). Nutritional Foundation and Clinical Application: A Nursing
Approach. Mosby.

Nix, S. (2022). Williams’ Basic Nutrition and Diet Therapy (16th Edition). St. Louis, Missouri:
Elsevier.

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