Above are the Nutrition Facts for an 8-ounce serving of Blueberry Yogurt. The 39 grams of sugar shown on the Nutrition Facts are a combination of lactose in the milk, fructose and sucrose in the blueberries and sucrose in table sugar. The only way to know how much sugar is added and how much sugar is natural is to do a little detective work.

Above are the Nutrition Facts for an 8-ounce serving of Plain Yogurt. There is no added sugar (because there are no added sugars in the ingredient list) so the 17 grams of sugar shown on the Nutrition Facts is coming from lactose in the milk.

So you might be thinking well how much added sugar do I need in the first place?

The World Health Organization recommends < 10% of your total Calories coming from added sugar. This would mean that someone eating a 2,000 Calorie diet would want to limit their added sugar intake to 50 grams (about 13 teaspoons). Not much more than the sugar found in a 12 ounce soda.

The American Heart Association a more conservative recommendation for maximum added sugar: Just 25 grams (about 6 teaspoons, or 100 Calories) for women, and 38 grams (about 9 teaspoons, or 150 Calories) for men.

I don't encourage people to keep track of their added sugar intake (it would be almost impossible to do since labels don't specify the type of sugar in processed foods), but I do encourage people to focus on WHOLE foods that are minimally processed and to consume added sugars and foods with added sugars in moderation.

D. Enrichment. Enriched vs. Whole Wheat Bread

The lecture outline tells you that if a food label uses the term enriched, it means that 5 specific nutrients are required to be added to white flour and its products as well as to white rice. Those 5 nutrients are added at levels about what they would have been before the flour or rice was partitioned.

The Enrichment Act requires that these 5 nutrients be added to all refined grain products before they are sold, so you only see in stores white flour that says "enriched".

The brown part of the above bar chart represents the thiamin content of a slice of WHOLE wheat bread. The green part represents the thiamin content of a slice of white bread. Notice they are about equal because the white flour used in the white bread is required to be enriched with thiamin, riboflavin, niacin, folic acid and iron.	Notice above that a slice of WHOLE wheat bread has significantly more vitamin B₆ compared to white bread because white bread is not required to be enriched with vitamin B₆.
Below is an illustration that shows other nutrients "enriched" flour is low in compared to Whole Wheat bread.	Sometimes a bread looks like it would be whole grain, but actually just a small part of the flour is whole.
The first ingredient of this Cracked Wheat bread is wheat flour (see above ingredient list) but that wheat flour is white. If a bread is called "Wheat Bread", its first ingredient is probably white flour or enriched wheat flour. (White flour = enriched wheat flour). Wheat flour is a generic term. If it is enriched it is white flour, it is whole, it will say whole wheat flour. It says the wheat flour is unbleached. Bleached and unbleached flour have almost the same nutrients. Consider them equal and consider them both white flour.	A clue that it doesn't have much whole wheat is the fiber content. If it was a whole wheat bread it would be a good source of fiber, > 10% DV.
	This fiber content of this "Whole Grain White" is misleading, I think, because the first value is for TWO slices. The first ingredient is "ENRICHED BLEACHED FLOUR" (white flour which it calls wheat flour, then it lists barley flour, then the B-vitamins it's enriched with including niacin, thiamin, riboflavin and folic acid and the mineral it's enriched with, iron). The remaining ingredients are: WATER WHOLE GRAIN (whole wheat flour, brown rice flour [rice flour, rice bran) WHEAT GLUTEN CONTAINS 2% OR LESS OF EACH OF THE FOLLOWING: BUTTER (CREAM, SALT) CALCIUM SULFATE MONO- AND DIGLYCERIDES ETHOXYLATED MONO- AND DIGLYCERIDES SODIUM STEAROL LACTYLATE ETC. So this bread is not a whole wheat bread.

These days, many breads that are made entirely with WHOLE grain flour use "100%" on the label. But to truly know if a bread is WHOLE grain you need to look at the nutrition facts. 1. Make sure it lists a whole grain (like whole wheat) as the first ingredient, AND 2. make sure it is a good source of fiber (DV >10% for fiber).

For more information on how to determine if grains are truly whole grain view this short powerpoint.

Now go back to the part of the lecture outline where you're asked to label whether you think the listed foods are WHOLE, PARTIALLY REFINED, or REFINED.

What would you say about "wheat flour"?

There are at least two reasons why processed foods are often cheaper than whole foods.

One is that processed foods can be stored longer before they need to be purchased or used. The germ in whole wheat flour has beneficial fats in it that can go rancid if not sold and used right away. Fresh vegetables and fruits have enzymes in them that cause the food to decompose. While the processed foods can be stored longer, the processing cause them to lose MANY beneficial nutrients.

The above photo of a 1980 Sno Ball cupcake was taken in 2006. The cupcake was just thrown away when we moved offices in 2010.

A second reason why processed foods are often cheaper than whole foods is that processing can divide a food (like corn) into many parts that then can be sold individually. It's not the farmer who sees this profit.

Consider what happens when a farmer sells his or her corn. That corn can then be processed into many products.

In his 2006 book The Omnivore's Dilemma: A Natural History of Four Meals, Michael Pollan writes, “Every farmer I've ever met eventually gets around to telling the story about the food industry executive who declared 'There's money to be made in food, unless you're trying to grow it.'” (page 95 of The Omnivore's Dilemma)

Refining is used to obtain other additives used in food processing besides sweeteners.

Three additives make up the "fiber blend" of the pasta on the right. All 3 of these additives (inulin*, xanthum gum and pectin) are non-digestible carbohydrates made by plants, but in the case of this pasta, it takes a factory to refine them from the plants, the way it takes a factory to refine table sugar from beets or corn.

When I did a web search to find out where inulin is manufactured, I found 4 regions listed. The majority were in mainland China, some were in the U.S and others were in Australia and Vietnam.

Persons choosing to eat foods with inulin should watch for signs of gas and bloating, which occurs in some people. Note that the pasta also has the additive wheat gluten. Gluten is a protein naturally found in wheat, but gluten intolerance is becoming increasingly common, including among people with diabetes.

* "Inulin" is no relation to "insulin". It gets its name from inula, a large genus of about 90 species of flowering plants in the family Asteraceae, native to Europe, Asia and Africa.

The following website shows you an alphabetical listing of additives (including the sorbitol you see in this pasta) with an evaluation of their safety: CSPI's Guide to Food Additives (Center for Science in the Public Interest).

What it says about sorbitol is:

"Some diabetics use sorbitol-sweetened foods because it is absorbed slowly and does not cause blood sugar to increase rapidly. Moderate amounts of sorbitol are safe, but large amounts may have a strong laxative effect and even cause diarrhea."

III Digestion and Absorption of Carbohydrates

After eating, nothing needs to happen in the digestive tract to the monosaccharides in a food like grapes because they are already small enough and they are absorbed as is. Disaccharides in that grape or in a food like milk are broken down in the digestive tract to monosaccharides. Grapes would have sucrose (in addition to glucose and fructose) which would be broken down in the digestive tract to glucose and fructose, which would be absorbed into the villi. The milk would have the disaccharide lactose which would be broken down in the digestive tract to glucose and galactose. Starch in food would be broken down in the digestive tract to glucose molecules. Fiber in food would NOT be broken down in the digestive tract because we don't have the enzymes to do that.

The Video Clip below shows Loretta Plaa, retired nutrition faculty at LCC giving a very fun explanation of the anatomy of the digestive tract.

Video Clip: Villi
approximately 12 minutes

Villi video

Which foods listed below have carbohydrates that need to be enzymatically digested?

Click here if you think Table Sugar has carbohydrate that needs to be enzymatically digested.

Click here if you think Butter has carbohydrate that needs to be enzymatically digested.

Click here if you think Soybean oil has carbohydrate that needs to be enzymatically digested.

Click here if you think Chicken has carbohydrate that needs to be enzymatically digested.

Click here if you think Eggs have carbohydrate that needs to be enzymatically digested.

Click here if you think Pinto Beans have carbohydrate that needs to be enzymatically digested.

Click here if you think Spinach has carbohydrate that needs to be enzymatically digested.

Click here if you think Peas have carbohydrate that needs to be enzymatically digested.

Click here if you think Apples have carbohydrate that needs to be enzymatically digested.

Click here if you think Pasta has carbohydrate that needs to be enzymatically digested.

You should now be able to fill in "B" and "C" of III in your Lecture Outline. If you have questions about this post them in the forum.

There are two locations in the body where bacterial digestion of carbohydrates can be a problem. One is the mouth and there other is the colon (large intestine).

As your lecture outline says, what happens in the mouth after eating foods containing starch or sugar is that the plaque bacteria eat and digest the starch or sugar. They then produce energy by anaerobically (without oxygen) breaking down the resulting glucose. The process of breaking down glucose anaerobically for energy is the glycolysis (shown in the image below).

Use the image below to fill in some of the other blanks you will see on the last page of your lecture outline.

The C on the image below = carbon. Cellular respiration is actually step 5 of the Wilbur Drawing. During cellular respiration, glucose combines with oxygen (and certain enzymes). This breaks apart the glucose releasing energy as ATP and producing CO₂ & H₂O.

What is left on the teeth as a result of this anaerobic breakdown of glucose is pyruvic acid. This pyruvic acid destroys the enamel of teeth with the result being cavities.

A few of the ways to decrease your risk of cavities are:

Limit refined foods with sugar.
Brush often.
Floss regularly.
Chew sugar free gum sweetened with xylitol.
Have teeth routinely cleaned by a dental hygienist.

The second location in the body where bacterial digestion of carbohydrates can be a problem is in the colon.

Humans, like most other mammals from buffalo to yaks, produce lactose for the milk to nurse their young. It gives their milk an appealing sweet, but not overly sweet, taste. (It has about half the concentration of sugar as the average soft drink.)

This photo of a nursing elephant, as well as the following photo, was taken by Courtney Fitzpatrick, who grew up in Eugene. As a doctoral student at Duke University in North Carolina, her research took her to Kenya.

This is at the David Sheldrick Wildlife trust in Nairobi, an organization that cares for orphaned elephants and then eventually reintroduces them to a specific state park in Kenya. Apparently they have pretty high success rates, although it takes a huge amount of human hours to care for them!

The enzyme lactase, made by a baby, breaks down lactose into two simpler forms of sugar (glucose and galactose), which are then absorbed into the bloodstream and provide glucose to fuel a baby's rapid growth. While fat in the milk can provide energy for the baby's muscles, as we've discussed, glucose is the only significant fuel the human brain and nervous system usually uses.

Once a baby stops nursing, most slowly lose the ability to make lactase. While this condition is called lactose intolerance, it's the normal condition for most of the world. About 75% of the world's adults are lactase-deficient, including most Asians, Southeast Asians, Africans, Middle Easterners and Native Americans.

Northern Europeans, among whom lactose intolerance is uncommon, have at least a 10,000-year history of dairying and milk consumption which is different from most of the rest of the world. A hypothesis is that at some unknown point in time, a mutation or adaptation occurred that enabled Northern Europeans to produce the enzyme lactase and digest milk as adults. Through natural selection, the frequency of the genetic trait for lactose tolerance increased in dairying societies because individuals with this genetic trait had the advantage of being better nourished. Not only did the milk provide protein, also their calcium absorption was increased by the lactose and the small amount of vitamin D in the milk. In societies living closer to the equator such as in Africa, the sun's ultraviolet light helped them manufacture vitamin D. In Northern Europe, cloud cover limits sunlight for much of the year.

Human intestines are full of bacteria that are not lactase-deficient. The bacteria break down lactose because they want the fuel it can provide. This intestinal fermentation produces hydrogen and other gases and molecules that attract water. This can produce symptoms like nausea, gas, bloating, cramps and diarrhea.

For a person with lactose intolerance, symptoms begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. One term, a student told me that “lactose intolerance is one of those sliding scale things“ and she was exactly right. The severity of symptoms depends on many factors, including the amount of lactase a person makes and the kinds of bacteria they host. For these reason, not all people deficient in lactase have the symptoms commonly associated with lactose intolerance.

We definitely do not need to drink milk as adults but what we DO need is calcium and some people find it difficult to get enough calcium without drinking milk. Later in the term, we'll talk more about getting calcium, but what will say is:

Getting enough calcium if lactose intolerant:

Drink 1/2 cup milk WITH meals OR drink milk w/ lactase added.
Yogurt without added milk solids because those add lactose. When making yogurt, sometimes milk solids are added to make it firmer.
Aged, hard cheese, like Parmesan because bacteria ate most of the lactose during aging
can you name some other sources of calcium?

IV In the Body: Glucose As Fuel

After eating foods with carbohydrate, these carbohydrates are digested by enzymes down to monosaccharides and these monosaccharides are absorbed into the blood. Then the fructose & galactose are changed to glucose in liver.

Sugar (glucose) then leaves bloodstream and enters cells. Insulin (a hormone made by the pancreas and secreted into the blood) helps the glucose enter the cells. You can think of insulin as a key that opens the door for glucose to enter cells.

IF ENERGY IS NEEDED, the glucose is split apart in body's cells to release the energy.

If energy is NOT needed, the glucose is stored as glycogen or changed to fat.

When your blood sugar falls, you receive messages from your brain & nervous system to eat. If you don't eat, your body's first way of getting glucose to raise your blood sugar is to break apart the glycogen in the liver. (Glycogen in the muscles can only be used in the muscles so it doesn't get into the blood to travel to other parts of the body).

Hormones that sends messages for this to happen are glucagon (made by the pancreas) & epinephrine (the major stress hormone).

From the above explanation, you should now be able to answer these questions:

What do insulin & glucagon have in common?

How are insulin & glucagon different?

If you're not sure, post a question in the forum.

If you have already used up your liver's glycogen, the next way your body has of getting glucose is rearrange the protein in muscles into glucose.

Which of the components of muscles are surprising to you?

So when your blood sugar falls & liver glycogen is gone, protein in muscles can be used to raise your blood sugar.

Now you should be able to list the 3 ways your body can raise your blood sugar.

1. Eat 2. Breakdown liver glycogen 3. Rearrange protein into glucose

Notice there is no mention about fat above. If you were in a situation where you would need to rearrange protein into glucose (starvation or a very low calorie diet) you would be using fat as a fuel, you would just NOT be using significant amounts to make glucose for the brain.

When your body has excesses of glucose because you've eaten more than you need, it gets stored as fat. Eating lots of sugar or starch usually does not lead to sustained high blood sugar levels because insulin helps that glucose enters cells, where it can be changed to fat if the glucose is not needed.

When your cells are deficient in glucose, it causes a buildup of ketones in blood, something that is called ketosis.

Look again at the Cellular Respiration illustration that is in your lecture outline and use the image below to fill in another blank.

The Krebs Cycle is the aerobic part of Cellular Respiration, meaning that part requires oxygen. Can you see that oxygen is added to the Krebs Cycle, but not to Glycolysis? And can you see that the Krebs Cycle needs glucose to get started?

When fat is used for energy, the 2-carbon fatty acid fragments go though the Krebs Cycle. But if glucose is not in the cells, the Krebs Cycle can't happen and the 2-carbon fatty acid fragments combine to make 4-carbon ketones, shown below:

One situation that can lead to less glucose being in cells and therefore ketosis is starvation. Another is uncontrolled diabetes because there is not enough insulin to help glucose enter cells or cells do not respond to the insulin. You have also probably heard of people going into ketosis by eating a high protein, low-carbohydrate diet (< 50 grams per day).

Symptoms of ketosis include decreased appetite as well as increased thirst & urination. Ketones are excreted from the body by several routes, including the mouth and the urine. Since they leave a disagreeable taste in your mouth, ketones can decrease appetite.

In order for the kidneys to work effectively, they like substances that come their way (be they salts or sugars or ketones) to be dissolved in plenty of water. So the kidneys signal you to drink more. And later you urinate more.

Short-term ketosis itself might not be dangerous, except if a person has diabetes or is pregnant. But if your body is in ketosis, what does this also mean is happening in the body?

(Hint- If you're in ketosis, it means your cells aren't getting enough glucose. So how will your body make sure your brain gets some glucose?)

Symptoms of hypoglycemia include weakness, headache and confusion. Some people with hypoglycemia have symptoms but normal blood sugar. Hypoglycemia may be caused by frequently changing from a low carbohydrate diet to a diet with lots of sugar.

When a person rapidly eats lots of sugar, the pancreas gets a VERY URGENT message to secrete insulin. Lots of insulin is secreted and blood sugar plunges.

The cause of true hypoglycemia may be a tumor of pancreas or hepatitis of the liver or other disorder.

The DIAGNOSIS of Hypoglycemia (& diabetes) is the Glucose Tolerance Test. To find out more, watch the short Video Clip below.

People with Type 2 diabetes make enough insulin, but their cells are resistant to the insulin. They are sometimes given a pill that stimulates the pancreas to make even more insulin, but that pill is not actually insulin.

Type 2 diabetes is an advancement of the insulin resistance seen in pre-diabetes. To read more about insulin resistance and type 2 diabetes check out the following website:

National Diabetes Information Clearinghouse (NDIC)

If you're interested below is a video that describes the causes and complications of type 2 diabetes a bit more.

The treatment for Type 2 diabetes has 4 parts:

Diet- high in vitamins, minerals & complex carbohydrates (starch & fiber) moderate in protein, low in saturated and trans fat and moderately low in added sugars.
Weight management to maintain desirable weight & improve cell's sensitivity to insulin
Exercise and
Stress management

Is this different than recommendations for people without diabetes?

Rates of diabetes are exploding world-wide because all over the world, obesity is a problem. Body fatness is strongly associated with the development of diabetes. Diabetes is surging worldwide, By Marc Santora, June 18, 2006, International Herald Tribune. Here's part of what this article says:

"There are many factors driving the growth in diabetes worldwide, but most experts agree that changes in lifestyle and diet are the chief culprits, in addition to genetic predisposition. As developing countries rapidly industrialize, people tend to do work involving less physical activity. At the same time, the availability of food that is cheap but high in calories becomes more common.

"The combination causes weight gain, which leads to greater risk of developing Type 2 diabetes, the most common form of the disease. The other form, Type 1, is responsible for 5 percent to 10 percent of cases and is not associated with behavior but is believed to stem almost entirely from genetic factors."

END of L4B