The role of carbohydrate in human health

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TheFood DrinkInnovationNetwork www.fdin.co.uk
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The role of carbohydrate in human health a case
for new products

• Functional Foods
• Melton Mowbray

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Complex nature of the relationship between food
and health
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Disease Risk and Body Mass
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Obesity Past and Future
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The problem we are faced with

• An ever increasing rate of obesity
• 1000 deaths a week are directly related to
  obesity
• It will soon become the most common preventable
  cause of cancer
• Type 2 diabetes
• CHD rates remain high

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Massive changes in life style
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Massive changes in the life style

• Energy expenditure down
• Access to cheap calories energy dense calories
• Public health looking into a bottomless precipice
• If we go on as we are in the few generations time
  will be the first where children die before
  parents

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Role of carbohydrates
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Carbohydrate is a complex groupwith complex
absorption
Gut lumen Epithelium Portal vein
Small intestine
Monosaccharides Glucose, Fructose Monosaccharides
Disaccharides Sucrose, Lactose Brush boarder enzymes Monosaccharides
Rapidly absorbed and slowly absorbed starch Pancreatic amylase Brush boarder enzymes Glucose
Large intestine
Non starch polysaccharides Resistant starch Fermentation Butyrate Acetate Propionate
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Carbohydrate The complex group
Class Free sugars Short-chain
CHO Starch Fibre (non-starch
polysaccharides)
Components Mono disaccharides Sugar
alcohols Oligosaccharides Insulin Rapidly
digestible starch Slowly digestible
starch Insoluble Soluble
Comments Sorbitol Large bowel effects,
stimulate bacterial growth Probiotic Amylose Amyl
opectin Little metabolic effect Metabolic
effect
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Dietary fibre (non-starch polysaccharides)
Water Soluble Water Insoluble
Hemicelluloses Pectins Gums Mucilages Carageenan Agar Celluloses Lignin Resistant starch
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Problems with definitions

• Physiological definition does not help chemical
  analysis
• Does not help interpretation of scientific work
  (dietary fibre v whole grain)
• Does not help public understanding
• Does not help labelling of produces

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What is Glycaemic Index
Incremental area under the blood glucose response
curve for food
X
100
Corresponding area after equi- carbohydrate
portion of glucose
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Glycaemic index
FOOD White bread Wholemeal bred Brown rice White
rice Boiled potato Pasta Yam Green
banana Sucrose Baked beans Chickpeas
GI 100 100 81 81 98 65 74 65 83 70 60
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Second meal effects
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Epidemiological evidence
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Overall view of GI and diabetes
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Review of glycaemic index and lipids (Ludwig 2002)
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Insulin Resistance

• Insulin sensitivity insulin stimulated glucose
  disposal
• Insulin resistance abnormal carbohydrate
  lipid metabolism
• Insulin Resistance Syndrome (Reaven, 1988)

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The Insulin Resistance Syndrome
Insulin Resistance
Hyperinsulinaemia
? Triglycerides
? HDL- chol
Glucose intolerance
?? B.P.
Small, dense LDL
? Uric acid
? PAI-1
Coronary Heart Disease
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Insulin Resistance

• Relative inability of insulin to stimulate
  glucose disposal

Insulin sensitive
Insulin resistant
GENES
ENVIRONMENT
? ? RISK CHD AND TYPE II DIABETES
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Possible model of insulin resistance
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Effect of a HGI and LGI diet on glucose day
profiles in middle aged men
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Post prandial metabolism
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Obesity evidence

• 16 single-day studies in humans, 15 found lower
  satiety, increased hunger, or higher voluntary
  food intake after consumption of high- compared
  with low-glycemic index meals
• obese children were given high-glycemic index
  instant oatmeal or low-glycemic index steel-cut
  oats with identical energy and macronutrient
  content at breakfast and lunch, and ad libitum
  energy consumption was monitored throughout the
  afternoon. Energy intake was 53 higher after the
  high- compared with the low-glycemic index meals
• Slabber et al found significantly more weight
  loss in obese hyperinsulinemic women after 12
  weeks of consuming an energy-restricted
  low-compared with high-glycemic index diet
• Bouche et al found lower adiposity by DXA scan in
  11 obese men after 5 weeks on an energy- and
  nutrient-controlled low- compared with
  high-glycemic index diet

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The Gut Hormones
Gastrin Ghrelin
Pancreatic Polypeptide
Secretin CCK
GIP Motilin GLP1 GLP2 Oxyntomodulin Neurotensin PY
Y
GLP1 Oxyntomodulin PYY
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PERIPHERAL SIGNALS REGULATING APPETITE
HYPOTHALAMUS
PYY3-36
GHRELIN
LEPTIN
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Can food release gut peptides

• The big challenge

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Nutrient Release of Gut hormones

• Consistency of food makes a difference to peptide
  realise
• Gasrtic emptying (Frost etal 2000)
• Products of fermentation make a difference
• Ileo break
• Effect gastric emptying (Frost etal 2003)
• Adding propionic acid increases GLP-1 release,
  lows gastric emptying and decreases hunger (Frost
  2003)

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Evidance of effect of Low GI diets and gut
hormones

• Evidence from a number of short term studies
• Holt etal 1992 CCK
• Juntunen etal 2002 GLP-1 and GIP (wholegrains)
• Tappy etal 1986 GIP

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Effect of GI on postprandial metabolism
Gut peptides
Gut peptides
Gut peptides
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Glycaemic index
FOOD White bread Wholemeal bred Brown rice White
rice Boiled potato Pasta Yam Green
banana Sucrose Baked beans Chickpeas
GI 100 100 81 81 98 65 74 65 83 70 60
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Problems of intake in whole grains

• Benefit is seen at 2-3 servings a day
• Consumption in a lot of Western countries is less
  then 1 serving a day
• Scandinavians consume more whole grain. Norway
  has 4x US intake
• Main sources are limited to wholemeal bread, rye
  bread and whole grain cereal

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Problem of who eats high fibre/wholegrain foods

• US and UK
• Older
• High socio-economic group
• Less likely to smoke
• Do more exercise
• Part of a healthy middle class lifestyle
• Many chronic diseases are associated with low
  income, smoking, lack of exercise and are rooted
  in the young

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Need a new raft of products

• Need to compete with commonly consumed foods
• Need to be seen as products with added value
• Ongoing research collaboration with Holgrain and
  RHM is trying to do this with with bread
• Is it possible to product a low GI white bread
  which will compete in the market place

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TheFood DrinkInnovationNetwork www.fdin.co.uk