This week, you will learn about carbohydrates.

There are general dietary requirements, whether in foods, how our bodies process them, and how are they're utilized. Whole grains, fruits and vegetables are important parts of the nutritious diet and are healthy sources of carbohydrates. Added sugars may not provide nutrition, but that does not mean we can never have a slice of pie or sweeten our tea. Relatively, recently, carbohydrates of a whole have gotten a bad-rap and that was true, excess sugar intake is associated with disease risks and increases in morbidity. We cannot simply say that all sugars, all carbohydrates are bad. It's not just about the simple sugar. Whole grains, fruits, vegetables, these are all carbohydrates. Fruits contain sugar and in moderation, sugar can be a part of a healthy diet. So carbohydrates as a whole, have been framed for crimes they did not commit, at least not alone. Sugar has been accused of causing diabetes, cavities, hyperactivity, and weight gain. And though sugar may be playing a roll in all these conditions, sugar itself does not cause any of them. So let's consider the evidence behind each accusation. Can sugar cause diabetes? Type one diabetes is an autoimmune disorder, regardless of what a person with type diabetes eats, they will always have it. Proper nutrition is part of managing type one diabetes, but it's not cause for malnutrition. Type two diabetes has many causes. It's a multifactorial disease progressing from insulin insufficiency or resistance. Once someone has diabetes, a good diet with regulated carbohydrate intake will be part of the treatment playing. First factors for developing insulin resistance include obesity, high blood pressure, high cholesterol, sedentary lifestyle, genetics, polycystic ovary syndrome, and aging. It's a much more complex than sugar causes diabetes. And we see, as life goes along, we roll around and our bodies deteriorates depending on how well we do or do not take care of them. We cannot isolate any one of these as causing diabetes. They are certainly part of a process, and then, once someone is diabetic, these are all conditions one would want to manage and one would also want to manage their carbohydrate intake, but again, we cannot say sugar makes you become diabetic. Is sugar rotting your teeth or a little sugar

monster is chipping away at your teeth with every bite? Well, just like diabetes, the development of dental care is, is also a multi, multifactorial phenomenon. While sugar fuels the organism responsible for dental demineralization, sugar at own does not break down tooth enamel. The bacteria responsible for this process is s mutans. Caries its caries formation will begin with a demineralization of tooth enamel from the acids in the mouth. The activity of this s mutans actually will cause this acid production, as well as any acid that you consume like orange juice is an acidic food that will add to the acidic environment. So, this s mutans who metabolize specifically from minimal carbohydrates that you eat. So whether that be a cookie or a caramel bread orange juice, the bacteria will break it down, and there, metabolic processes produce acids in the mouth. Over time, these acids will continue to build up to a point where you can change the ph of your mouth. Once you change the ph of your mouth, demineralization will begin. In addition to this, the process of this bacteria also induces the formation of plaque and these pockets of plaque on your teeth enhance the environment and make it hospitable for the s mutans to continue with s production, acidifying the mouth, and causing demineralization of the tooth. A demineralization continues if it reaches the dentin as you continue to eat. Over time, we can break it down enough to cause a carie. Now, we think about what kind of foods are bad here or less healthful. The foods that are responsible are any fermentable carbohydrate. An apple, an orange, a caramel, a soda, a candy bar. Some foods are less cariogenic than others, that means they have less capacity to cause caries and also the ph of a food will have an impact here. Well, think about some of the foods maybe you could've chosen for oral health. Oral hygiene is always important keeping the mouth clean, keeping debris off the mouth. It's going to be very important. We're just going to focus a little bit on food component here. So, let's think of some foods you might choose. How about an apple and cheese? Well, the apple has sugar as a fruit. The cheese does have some sugar. It's, it is based of milk. So there is some amount of carbohydrate in both, but this is not a very sticky food. It's not going to stick to your teeth. The fresh apple, the uncooked, unprocessed apple is less

cariogenic than a processed apple would be. But, especially, if you added sugar to the apple and made like a dessert and certainly apple acids sitting on your teeth long term might not be good, but that's not one we consider highly, highly problematic. How about some soda and pasta? Well, there's sugar in the soda and in the pasta, and there's acids in the soda. So these are formidable plus acidic, so yesm they certainly would lend themselves more demineralization or to exasperating demineralization. Milk and carrots, okay again, both have sugar, but their forms are less cariogenic. How about orange juice and a breakfast muffin? While orange juice is certainly helpful, it's got vitamin C, it's a nice part of your breakfast. A breakfast muffin, well, you know, it certainly could be a choice. It might be less helpfu, but Combined with foods from animal carbohydrates, potentially that stickiness of that muffin and the actives in your juice are going to promote demineralization in carriage formation. How about veggies and the chicken? Well, these are also going to change some carbohydrates probably have certain half carbohydrates, but they are not going to be highly cariogenic and not highly suitable for eating and demineralization. So I've used some terminology and listed some different foods that might be increasing the risks of developing dental caries. Foods that are going to be inducing more demineralization because of what they do to the oral environment and these terms that I've used just to help you understand what they are. Acidic foods can be termed acidogenic, they do decrease the oral pH quickly. Cariogenic foods are the fermentable carbohydrates as I mentioned that will be metabolized by the bacteria in your mouth to also reduce the pH in the mouth. Cariostatic foods, now, they do contain some sugars, but they're really not metabolizing by the bacteria into a point where they're going to actually drop the pH of your mouth. And lastly, anticariogenic foods that I didn't mention, but which are very important, can actually prevent cariogenic activity and the two that really come to mind are xylitol in sugar free gums and cheese. So cheese is actually a really great healthy snack option, for example. We'll talk a little bit about this in future lectures. But in pregnancy, one might want to eat smaller, more frequent meals if one's

feeling significant amounts of nausea and a healthy snack for keeping good oral health in pregnancy would be a low fat cheese stick. This will be much better than something that seems healthy like a granola bar. A granola bar is sticky, a fermentable carbohydrate and it would be more likely to induce demineralization and various development. Another thing that's very important is how often you eat and what type of foods are in your meals or snacks together. So if you eat, eat more often then there's more chances that you're bringing in fermentable carbohydrates, potentially acids and you are activating those bacteria, so each time you eat, that pH could drop, the more often the pH drops the more likely you are going to see demineralization occur. So, more often, eating more often would be a risk factor for higher chances of developing dental caries. Also, if we have snacks that are high in fermentable carbohydrates and that's all they're made of, so a snack, like I just said, a granola bar versus a cheese stick, that snack has nothing else in it. It's going to be more likely to induce the development of dental caries. If I have that granola bar in a meal where there's lots of other foods, so maybe it was part of my lunch. I had a granola bar with a cup of yogurt and a nice bottle, cup of water to go with that those foods would combine to decrease what's happening in the mouth. Another thing that's important is rinsing the mouth out so those fermentable carbohydrates don't stay there and that's done with basic water and also making sure that you have enough saliva. Individuals with conditions such as dry mouth also have a higher risk for developing dental cavities, because the saliva isn't there to help the mouth. Alright. So does sugar cause hyperactivity? Was it that candy bar that got your kids running and screaming through the market? Well, even though it might seem like it, sugar is not the best choice for a growing child, but it's not going to cause hyperactivity. Now, it might spike blood sugar and have other negative effects if eaten in excess, but it's not causing the hyperactivity. While I'm free of being, blaming stimulants like caffeine and sugar, poor nutrition and micronutrition imbalances can have detrimental hormonal effects and the treatment of chronic malnutrition has been associated with improvements in behavioral

issues, but overall, we can't just blame sugar. That's much too simplistic. There's far more at play here. Good healthy diet is very important for having a healthy child that does behave properly and even so a child with a very healthy diet may still have other factors coming into play that can lead to behavioral problems. How about weight gain? Can we blame the carbon sugar for tipping the scale? Now, they have been the target of ketogenic diets like the Atkins diet or South Beach diet and low fat craze is widespread, we can see it on our supermarket shelves. This comes about because people are struggling to find an easy solution for their battle with obesity, and the hardest part about weight management is not what you should or should not eat. We know what we should or should not eat or at least what we should eat more or less of, but it's making that happen. So combining our food choices with dealing practical, financial, emotional challenges, limitations in time and energy, overcoming stress or lack of motivation. Those I would say are far more likely to blame for our challenges with food. If we wanted to blame any sugar, we would maybe look to the added sugars in our food. These are going to be less satisfying and less satiating and we're more likely to overeat sugary, empty calorie foods than a high fiber carbohydrates. So if we think about this, let's break this down. If you, your body, burns one, 953 calories a day and you eat 1,950 calories a day, just carbohydrates. Maybe just apples, for example, or just grapes. Will you gain weight? Now, even if they're just Twinkies, you're not going to gain weight. Can we blame certain foods for tipping the scale without regard to the quantity we consumed? How easy would it be to eat 1,500, 1,900, calories of apple versus 1,500, 1,900, calories of icecream? So if you're still guessing, the answer is no, carbohydrates don't make us fat. Calories, in excess, increase fat deposition and do lead to weight gain. There's no one food to blame for tipping the scale, even the cupcakes, veggies, burgers, all these foods can be part of a healthy diet, even our party things. When think about what this weight gaining, again, it's not multifactorial component. Even though, eating unhealthy might lead you to be hungry or type of vitamin or mineral deficiency. It's more the complex components that are going to lead to obesity. All the components to our food,

the proteins, the vegetables, the fruits, the whole grains, fiber, vitamins and minerals, play a role in our health. We need them, our body needs these components of food to make the machine run. It's the details of diet that dictate how healthy you'll be. If you're satiated by what you eat, if your body systems function normally, if your foo d helps you maintain even blood sugar and healthy digestion, if you have enough energy to do what you need to do all day long. If your food meets your body's needs, and meets your satiety needs, and taste needs, you're less likely to gain weight. Research indicates that the key to healthy weight management is self-awareness and self-monitoring. You not only know how much you're eating, you've all got an opportunity to self-monitor. Were you surprised by what you ate? When it comes to losing weight, burning more calories than you eat brings results. The best way to make sure that you're doing that is to write it down. So to summarize how can maybe carbohydrates seem to be tipping the scale, you may have talked to a friend or heard in the media it's the carbs that are making me fat. When I stop eating carbs, I lose weight. It's gotta be the carbs, it jus, that just makes sense. Well, if they're not writing what they're eating down, they don't know for sure how many calories they were eating before they cut carbs versus after they cut carbs. This balance is as simple as in and out, but the awareness and actual details of how much we're eating come to measurement. What you choose to eat depends on cost, time, taste, and who you're responsible for eating. Unhealthy food, empty calories, and a diet high in added sugar is more likely to bring in more calories, even though it does taste good, it's less filling than fiber, less satiating and much easier to overeat. Now, when people do go on low-carb diets, yes, there are physiological changes occurring. But over time, two individuals on low-carb versus moderate-carb diet eating the same amount of calories, having the same caloric need are going to both lose weight. So if there's any one key though to healthy weight management, I would say it's in fiber and protein with a little bit of fat. Fiber fills you up, protein keeps you full, and fat makes things taste good. All in moderation, again, but proper food combining the roles of food in our diet can also be a part. I was helping manage weight more easily, so while we're

talking about sugar, let's talk about the un-sugars, they've also been blamed for some things along the years, certainly some of them, more and more chemical in nature than others, and some individuals may choose not to consume them. They much rather just moderate their sugar or sweets intake, but since we'd like to know a little bit about what they mean and so that you can understand what they are, I will help a little bit about those. The first artificial sweetener to appear on the market was saccharin, tt was marketed as Sweet'N Low, and it still is, and in addition to the tabletop sweetener, you can find saccharin in low-sugar versions of foods, like gums or diet soda. Saccharin isn't digestible, but it is absorbed through the gut and will be excreted in your urine unchanged. It was the subject of some controversy due to some findings of associations with bladder tumors developing in male rats fed high doses of sodium saccharine, but following research did not find any significant association in human being. That being said, it is still a chemical that you are introducing into your body and just like every other nutrient or non-nutrient edible product, I would say moderation is the key. A newer sugar alternative actually derived from sugar is sucralose. It's marketed as Splenda. Splenda's useful in cooking, because it is highly stable and it will maintain it's sweetness. It does not provide calories because it isn't digested and like the other sweeteners, it will be excreted in the urine. A third kind of sweetener released is aspartame. This is sold as Equal and NutraSweet. Aspartame is used in diet sodas and other drinks. It's in processed foods and these foods will typically be marketed as low sugar. It's also used in sweetened medications. The compound aspartame is made of aspartic, aspartic acid and phenylalanine with, with Now, unlike other artificial sweeteners, aspartame cannot be used in cooking, it will be denatured and lose its taste. And the pri mary concern with aspartame is in certain individuals with phenylketonuria or PKU. Individuals with PKU cannot digest aspartame, it's toxic to them, this is because they can't break down phenylalanine. They actually are missing the enzyme phenylalanine hydroxylase or have insufficient amounts to convert phenylalanine to tyrosine. These are both amino acids. When you cannot convert phenylalanine to tyrosine,

phenylalanine, phenylalanine will build up in the blood and cause toxicity, particularly in the brain. So people with PKU do need to avoid foods rich in phenylalanine or any alternative sweetened product or any alternative sweetened products with Equal or NutraSweet, with aspartame. And the food levels will actually contain information about their aspartame content and a warning. Other sweeteners may be marketed for their anticariogenic property, as I mentioned, or the sugar alcohols. These include sorbitol, mannitol, and erythritol. These are digested, but not metabolized and, or they're metabolized very slowly, and they do have minimal calories relative to sugar. Because the digestion is slow, not all the sugar alcohol gets absorb, absorbed and some of this can actually cause GI irritation and diarrhea . The good news for dentists is that sugar alcohols are not metabolized by, or bacteria. Chewing gums sweetened with sugar alcohols can help prevent cavities, because each stick gum helps clear the mouth, increase the saliva and there's not a fermentable carbohydrate. Looking at a gum label, you'll actually see claims relating to artificial sweeteners sugarless or even the claim that it does not promote tooth decay. And again, this is because it's not broken down by bacteria. Finally stevia is derived from a perenial shrub and is 30 times sweeter than sugar. It's available in powder and liquid concentrate, tea, or tablet forms. Refined stevia is considered non-nutritive and is cariostatic. It's marketed as having no effect on blood sugar, but in current research is still underway to determine the effects of w hole leaf or crude stevia on blood sugar, the kidneys, and the cardiovascular, and reproductive systems. So, I hope you've learned a little bit more about carbs and what sugar does or does not do and can now be one to help stop blaming sugar for things that sugar was not causing.