Cyclical Ketogenic Diets Review

Keto Masterclass

The creator of the product is one of the most important influencers in the low carb diets, he was one of the few people to bring forth diets like the Paleo diet and the keto diet. In this guide and program, Robb will show you exactly how you can make progress using the keto diet. It will make you understand the truth behind the scams people put in the keto diet and how that is ruining the progress of many people. In this program, you will find out about how to diet effectively and use the keto diet to its full potential. More importantly, you will learn how to live with the diet and maintain the level of fitness you gained. It will also show you how you can get into the ketosis state so that you can burn your own body fat for fuel and energy. This will help you lose inches from your waistline and be healthier than ever. You will get the information almost immediately as you will get the download link to get the guide after you make a successful purchase. Another great thing about keto master class is that you can make a lot of progress even if you have no experience, so no matter what, you are guaranteed to get results. Continue reading...

Keto Masterclass Summary


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Keto Masterclass Review

Highly Recommended

Recently several visitors of blog have asked me about this book, which is being advertised quite widely across the Internet. So I purchased a copy myself to find out what all the excitement was about.

Overall my first impression of this book is good. I think it was sincerely written and looks to be very helpful.

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All About Complex Carbohydrates

Now that you know what you shouldn't load up on, let's take a look at the foods you should eat. By now, you should be clued-in to which foods are rich in complex carbohydrates (pasta, rice, grains, breads, cereal, legumes, and vegetables). Although they're actually made from hundreds or even thousands of simple sugars linked together, they react quite differently inside your body. After you ingest a complex carbohydrate (or starch), several enzymes break it down into its simplest form, called glucose. Glucose is the simple sugar that your body recognizes and absorbs. All types of carbohydrate (simple and complex) must be broken down and converted into glucose before your body can absorb and use it for energy. Simple carbohydrates (simple sugars) are molecules of single sugar units or pairs of small sugar units bonded together. Complex carbohydrates (complex sugars) are compounds of long strands of many simple sugars linked together. Another reason to choose complex carbohydrates is...

Do Pasta and Other Carbohydrates Hake You

In this era of trendy low-carb and no-carb diets, this may be the best thing you've heard in a while Carbohydrates will not make you fat Consistently overeating calories will make you fat and those calories may come from protein, fat and or carbohydrate. Always remember that appropriate amounts of high-quality carbohydrates will prolong your energy and improve your health. Furthermore, carbs are the body's preferred source of fuel. In fact, some of the body's tissues can only use carbohydrates to function optimally. Why all the confusion For starters, some people confuse weight gain from fat with weight gain from carbohydrates. One gram of fat has more than double the amount of calories as one gram of carbohydrate. What some people don't realize is that fat usually accompanies carbohydrates at a meal. For S Some excellent sources of carbohydrates include fruits, vegetables, legumes, brown rice, barley, couscous, oatmeal, pita bread, oat bran pretzels, whole wheat tortillas, high-fiber...

Aptamers to Carbohydrates

Aptamers to carbohydrates were originally isolated mainly for two different purposes. One was to use an RNA aptamer binding to the sephadex matrix as a purification tag for RNA or ribonucleoparticles (RNPs) from complex RNA mixtures. The other main purpose was to identify and block specific sugars on cell surfaces by using highly specific aptamers. For this purpose, not only the affinity but also the specificity of the aptamer is of great importance. By blocking the sugar on cell surfaces, many important mechanisms such as recognition, cell adhesion, metastasis, or viron infection could be disturbed. The Kd-values of the carbohydrate aptamers are often higher than those obtained for other macromolecules (Gold et al., 1995). Carbohydrates lack charged groups and aromatic ring structures, both motifs known to direct strong aptamer-target interactions. They only have hydroxyl groups, which are likely to form non-covalent bonds. Therefore, it is not surpris-

Solving the Pyramid Puzzle

Breads, cereal, rice, and pasta group Foods that come from grains sit at the bottom of the pyramid, creating a foundation for building a healthy diet. This foundation provides vitamins and minerals, along with complex carbohydrates (also called carbs or carbos), which serve as an important source of energy. To add some fiber to your diet, eat whole grains whenever possible. USDA guidelines recommend 6-11 servings per day. That might sound like a lot, but serving sizes are deceptively small, so they add up quickly A calorie is the amount of energy that food provides. The number of calories is determined by burning food in a device called a calorimeter and measuring the amount of heat produced. One calorie is equal to the amount of energy needed to raise the temperature of one liter of water to one degree Celsius. Carbohydrates and protein contain 4 calories per gram, fat contains 9 calories per gram, and alcohol has 7 calories per gram.

Biochemical pathways of ATP generation

The store of ATP is limited and must therefore be continuously replenished. Regeneration of ATP occurs through aerobic and anaerobic processes by which energy-rich chemical substances (carbohydrates, fat and phosphocreatine) are transformed into compounds with less stored energy (lactate, H2O, CO2 and creatine). This is achieved by sequences of chemical reactions by which part of the change in free energy is used for the synthesis of ATP through a reversal of reaction (1). The ATP-ADP cycle constitutes a basic feature of energy metabolism in all cells and is an intermediate between energy-utilizing and energy-consuming processes.

Energy expenditure during exercise

The total energy expenditure (TEE) of an adult person averages 10000-13000kJ 24h. Individuals with physically very demanding occupations may reach values of 17000-19000kJ 24h. The TEE is made up of three components the BMR, the dietary-induced thermogenesis (DIT) and the activity-dependent energy expenditure (Table 1.2. i). The BMR is normally the largest component of TEE, averaging 7000-8200 kJ 24 h in men and 5800-6200 kJ 24 h in women. The DIT, which is defined as the extra energy consumption resulting from a meal, normally accounts for one tenth of the TEE. DIT is largest after a protein meal, where it amounts to 18-25 of the energy contained in the meal, but considerably smaller for meals containing carbohydrates (4-7 ) and fat (2-4 ) 24 . The remaining part of the TEE is the activity-dependent energy expenditure (AEE), which can be calculated based on the 19.7 and 21.2 kJ of energy released for each liter of oxygen consumed during fat and carbohydrate oxidation, respectively...

Sweet Satisfaction The Lowdown on Simple Sugars

So your favorite sugary sweets are classified as carbohydrates and you're supposed to eat a lot of carbohydrates so it's okay to load up on gummy bears and licorice, right Not a chance. Here's why The quality of your carbohydrates matters tremendously. Simple sugars such as candy, sodas, and sugary sweeteners found in cakes and cookies offer little in the form of nutrition except providing your body with energy and calories. These foods are literally empty calories calories with no nutritional value. In moderation, simple sugars are perfectly fine (and, I admit, yummy), but people who consistently load up on the sweet stuff often find themselves too full for, or uninterested in, the healthy foods their bodies require. The end result is too much sugar and not enough nutrition. Actually, all foods that contain carbohydrates (rice, pasta, potato, cakes, cookies, and, yes, candy) can mix with the bacteria in plaque and increase your risk for tooth decay. Sadly, nutrient-dense raisins are...

How Much Carbohydrate Should You

As mentioned earlier, 50 to 55 percent of your total food for the day should consist of carbohydrates, specifically complex carbohydrates. In fact, 80 percent or more of your total carbohydrate intake should come from high-quality, complex carbs and naturally occurring sugars in fruits and vegetables. The amount of carbohydrate grams remains proportional to your caloric requirements. The more calories you require, the more carbohydrates you need to eat.

The Role and Structure of Mannose Binding Lectin

MBL is a multifunctional protein known to be exerting the following functions i) initiation of the lectin pathway through the binding of carbohydrates ii) opsonization of target structures iii) modulation of inflammatory response iv) promotion of apoptosis (Turner, 2003).

Getting Fat from Eating

The consequence from eating excessive fat is one that most of us know all too well weight gain. Gram for gram, fat delivers more than twice as many calories as carbohydrates and protein. In other words, high-fat foods (such as chips, cakes, and whole milk dairy products) are more calorically dense than low-fat foods (grains, fruits, and Even though excess calories from carbohydrates and protein can put on pounds, it's a lot easier to get fat from eating a lot of fat. One gram of fat supplies more than twice the number of calories your body gets from carbohydrates and protein

Making Better Choices

Because insulin secretion is a direct result of eating carbohydrates, should everyone stop or slash their carbohydrate intake Of course not The body is primarily fueled by carbohydrates diets too restrictive in all carbohydrates are unhealthy. However, people should learn to make better carbohydrate choices. This involves avoiding carbohydrates that are highly insulin producing or high-glycemic. Certain carbohydrates, such as white potatoes, white rice, white bread, corn, and beets, should be avoided or used sparingly. Foods containing more than five grams of added sugar are generally unhealthy. Check the labels of foods for unnecessarily added refined sugar these foods even though they may be low in fat will result In a high insulin response, causing the body to convert and store this sugar as fat.

Receptors Interacting with Covalently Bound C3 Fragments

CR3 is expressed on several cell types including all myeloid lineage cells, NK cells some B cells and DCs. Unlike the interaction between C3b and CR1, binding of iC3b to CR3 is sufficient on its own to initiate phagocytosis. In addition to binding iC3b, CR3 is one of the major adhesion molecules expressed by phagocytes. Like LFA-1, it interacts with ICAM-1, as well. It has a lectin-binding capacity and interacts with carbohydrates of other membrane constituents 21 . Triggering of CR3 via its lectin-site results in oxydative burst in phagocytes - a process where CR3 promotes transmembrane signalling by interacting with GPI-anchored membrane glycoproteins such as CD14, CD87 and FcyRIII 22 , By binding to ICAM-1, CR3 enhances the adhesion of monocytes and neutrophils to the endothelium in the absence of complement proteins and facilitates the accumulation of these cells at sites of tissue injury. CR3 on NK cells is involved in cytotoxic reactions by its dual ligation 23 .

Distal Half Of The Duodenum

The duodenum is the first part of the small intestine. The chemical digestion of food (i.e., carbohydrates to simple sugars fats to fatty acids and glycerol proteins to amino acids) primarily occurs in the duodenum because of the secretion of pancreatic enzymes. The remainder of the small intestine (i.e., jejunum and ileum) primarily functions in absorption of these nutrients into the blood stream.

Adding value to milk through the use of milk protein genomics

Ideally, a milk enriched in peptides promoting immune function, controlling blood pressure, acting as a bacteriostat and minimizing oxidative stress and cancer risk, while at the same time relieving depression and preventing dental caries, would seem to have the makings of a highly valuable functional food. Combining this with an enrichment with n-3 fatty acids thought to increase insulin sensitivity and therefore prevent diabetes, together with certain milk carbohydrates capable of improving cognition, adds greatly to a product that already acts as a rich source of amino acids and energy to promote normal growth processes. Manipulation of these proteins in milk will inevitably occur in the factory and potentially in the cow. The challenge remains to turn this speculation into commercial reality for the benefit of societies in both the developed world and the developing world.

Polysaccharides starch glycogen and fibre

Carbohydrates provide the body with energy and may be converted to body fat. All animals have a metabolic requirement for glucose but, provided the diet contains sufficient glucose precursors (amino acids and glycerol), most animals can synthesize enough glucose to meet their metabolic needs without dietary carbohydrate. However, sugars and cooked starches are an economical and easily digested energy source. Sugars increase palatability to dogs but cats do not respond to the taste of sugar. The value of certain carbohydrates is limited by the animal's ability to digest them. Digestion of disaccharides such as sucrose and lactose is controlled by the activity of the intestinal enzymes, i.e. disaccharidases sucrase and lactase. The activity of lactase decreases with age and so an excessive consumption of lactose-containing products in older animals can lead to diarrhoea.

Modifying Biomacromolecules

Biomacromolecules are oligomeric molecules that are composed of smaller building blocks in nature. The three major classes of biomacromolecules are proteins, nucleic acids, and polysaccha-rides, built up of amino acids, nucleotides, and carbohydrates, respectively. thus synthesis is easier and also the stability of PNA is increased compared to DNA. Another prominent example of DNA, or rather RNA, modification is LNA, where the ribose moiety of an LNA nucleotide is modified with an extra bridge connecting the 2' and 4' carbons (Figure 4.5). The bridge locks the ribose in the 3'-endo structural conformation, which is supposed to be an important bioactive conformation. This locked conformation of LNA enhances base stacking and backbone preorganization, as well as increases the stability of the nucleic acids. Both PNA and LNA are being pursued commercially as potential drug candidates, as well as diagnostic tools. Polysaccharides, such as starch and glycogen, are highly important...

TABLE 620 Diabetic Ketoacidosis

Patients with noninsulin-dependent diabetes mellitus present with marked increases in serum glucose concentrations without ketosis (nonketotic hyperglycemic coma) this entity is also associated with an increase in anion gap, but the chemical nature of accumulated anion(s) is not well characterized Elevated ketones may accompany starvation and alcoholic ketoacidosis, where there may be some associated acidosis (see below), as well as isopropyl alcohol intoxication that is characterized by ketosis without significant acidosis

TABLE 623 Lactic Acidosis Llactate

Aerobic tissues metabolize carbohydrates to pyruvate that then enters an oxidative metabolic pathway (TCA) in mitochondria this results in regeneration of NAD+ that was consumed in the TCA cycle, as well as in the glycolytic pathway The net effect of glycolysis is to generate lactate from carbohydrates

History and Geography

One explanation of the high frequency of type II DM among certain of these populations is that they developed a highly efficient carbohydrate metabolism under traditional life-styles of a feast and famine cycle. The thrifty mechanisms of carbohydrate metabolism, however, became detrimental with rapidly changing life-styles associated with a decrease in physical activity, an increase in energy in the diet, a reduction of dietary fiber, an increase of refined carbohydrates, and an increase in psychosocial stress.

Supercritical Fluid Chromatography

The number of compounds that can be analyzed by SFC is potentially enormous. Out of the 106 known compounds which are currently more or less well characterized, only about 15 can be volatalized without decomposition. Compounds such as proteins, synthetic and natural polymers, lipids, carbohydrates, vitamins, synthetic drugs, and metal organic compounds may well be analyzed by SFC.

Xion Chromatography Ic

Lon chromatography (IC) usually contains an ion exchanger or 'pseudo ion exchanger'. The ion exchangers are derived from cross-linked organic polymers by affixing to the polymer ionogenic groups that are the source or the vital ion exchange processes. The IC is used for the determination for both inorganic or organic compounds and even species as 'non-ionic' as carbohydrates.

Properties of spraydried milk products

A dairy powder is characterized not only by its composition (proteins, carbohydrates, fats, minerals and water) but also by its microbiological and physical properties (bulk and particle density, instant characteristics, flowability, floodability, hygroscopicity, degree of caking, whey protein nitrogen index, thermostability, insolubility index, dispersibility index, wettability index, sinkability index, free fat, occluded air, interstitial air and particle size), which form the basic elements of quality specifications there are well-defined test methods for their determination according to international standards (Pisecky, 1986, 1990, 1997 American Dairy Products Institute, 1990 Masters, 1991). These characteristics depend on drying parameters (type of tower spray drier, nozzles wheels, pressure, agglomeration and thermodynamic conditions of the air, such as temperature, relative humidity and velocity) and the characteristics of the concentrate before spraying (composition...

General Considerations

In the general American population, the lifetime probability for development of colorectal cancer is approximately 5.5 , or 1 per 18 people. The risk for this type of cancer differs widely among individuals. The highest incidence is in African Americans, who have a rate of 50.4 cases per 100,000 population. The incidence for the white population is second, at 43.9 per 100,000. The lowest incidence is in the Native American population, at 16.4 per 100,000. Some patients, such as those with congenital polyposis or ulcerative colitis, have a predisposition to the development of cancer of the colon, frequently at an early age. The lifetime risk of colonic cancer in patients with polyposis coli is 100 . The incidence of polyposis in the population of the United States varies from 1 per 7000 to 1 per 10,000 live births. The risk for development of colonic cancer in patients with ulcerative colitis is 20 per decade of life. Diet has been shown to have a relationship to the incidence of...

Perioperative Diabetic Management

Although satisfactory control of blood glucose may be achieved using a no-glucose no-insulin regimen, the raised blood urea concentration which often occurs in the postoperative period is indicative of increased protein breakdown, accompanying lipolysis and ketosis. Minor procedures may be carried out at the start of an operating list by delaying the morning dose of insulin until a late breakfast is taken after recovery from anaesthesia. A low-dose insulin infusion on its own (0.5 unit h_1 by syringe pump) is effective for minor surgery, but is not adequate for major surgery.

Patterns of Creative Activity

The research on which these contributions were immediately based took place within surprisingly short periods of time. From the beginning of his investigation of urea synthesis to the first publication announcing the outlines of the ornithine cycle, only 9 months elapsed. The broad problem of the oxidative metabolism of fats, carbohydrates, and several prominently identified intermediates occupied him As with other great achievements in science, the powerful integrations provided by the ornithine and citric acid cycles obscured the earlier progress made in the areas in which these discoveries impinged. Later biochemists tended to equate the work of Krebs, along with a few other landmarks in the 1930s such as the Embden-Meyerhof pathway of glycolysis, with the origins of intermediary metabolism. Because previous knowledge seemed afterward rudimentary and fragmentary, the new discoveries appeared to have fewer precedents than they actually had. It is true that, except for the sequence...

Making the Nutritional Guidelines Work for

The same nutrition recommendations that guide the general public are also appropriate for those with Type 1 or Type 2 diabetes. But diabetics on a fixed amount of daily insulin need to be vigilant about the amount of carbohydrates they eat, and how they time their meals.

Dietary Principles and Weight Loss

It is not necessary to attempt weight loss before instituting medical therapy, especially since weight loss alone may not provide any glycemic control in highly insulin-deficient patients. However, a multifaceted approach with education, reduced energy, and fat-calorie intake, increased regular physical activity, and other lifestyle changes can produce long-term weight loss and glycemic improvement. Less need for calories in elderly patients leads to obvious dietary changes. Of note, patients should not avoid breads and other starches in fact, complex carbohydrates are an important part of the modern approach to diabetes.

Dietary Recommendations

The 2008 ADA guidelines considered the risk and advisable intake of carbohydrates, fats, proteins, and other food ingredients. Monitoring carbohydrate by counting, exchanges, or experience-based estimation remains a key strategy in achieving glycemic control. Saturated fat should be less than 7 of calories, and there should be minimal trans fat. Total cholesterol should be less than 200 mg daily. Higher fiber intake may improve glycemic control thus fiber intake should be at least 14 g 1000 calories daily. Sugar, alcohols, and nonnutritive sweeteners are safe when consumed within daily levels established by the Food and Drug Administration (FDA). Usual dietary protein of 15 to 20 of calories is appropriate in diabetes in the absence of significant renal insufficiency. Reduction of protein intake to 0.8 to 1.0 g kg day in diabetic individuals with early stages of chronic kidney disease, and to less than 0.8 g kg day in later stages, may improve renal function. High-protein diets ( 20...

What are tumour markers

Tumour markers are biological or molecular substances (protein, carbohydrates, hormones, etc.) that can be produced and attributed to the events in tumorigenesis. They may be produced by the tumour cells themselves, or by the body in response to the presence of cancer, or in certain benign conditions, e.g. dermatofibroma, benign prostatic hyperplasia and benign prostatic hypertrophy. Those produced intra-cellularly, or on the cell membrane (oestrogen receptor - ER) are detected by immunohistochemistry (IHC) on the tumour tissue. Those secreted into body fluids can be quantified by immunoassay methods. The production of tumour markers can result from 2. Tumour-associated markers oncofetal antigens, oncogenes, oncoproteins, carbohydrates, hormones, enzymes, cytokines, soluble receptors, growth factors, cellular markers - not tumour specific, but expressed in higher levels than in normal tissue (CEA, AFP, p2M, p21 ras protein, vascular endothelial growth factor - VEGF).

Pathogenesis and Presentation

Diabetic ketoacidosis (DKA) results when an absolute or relative lack of insulin allows hyperglycemia to become dehydrating and lipolysis to become ketosis. This progression occurs over several days in patients who are usually unaware of their DM diagnosis. As dehydration becomes more severe, the brain begins to experience an increase in osmolality. Altered mental status begins with lethargy and coincident metabolic acidosis. The patient may become dependent on others to secure medical care if care is further delayed, lethargy becomes stupor and eventually coma. The pH falls to 7.00 or lower. The crisis has been defined.

Crisis and Sodium Bicarbonate

Insulinization with saline infusion for 2 hours is usually sufficient to halt ketosis and gluconeogenesis and begin reversing metabolic acidosis. Rarely, life-threatening acidosis exists with pH below 6.90. Blood pressure and cardiac output may be compromised. The anion gap may be approaching 40 mEq dL, suggesting a coexisting component of lactic acidosis. These are the extreme conditions that justify consideration of sodium bicarbonate (NaHCO3) infusion. The concern involves the serum potassium, which could shift intracellularly with a rapid rise in pH. If present, hyperka-lemia would be an overall benefit, but if the ECG is indeterminate or hypokalemia already exists, a further decline in serum potassium would be disastrous. Thus, administration of sodium bicarbonate should be done slowly with caution. Bolus therapy with 100 mEq NaHCO3 can also cause a transient hyperosmolality. with a potentially deleterious water shift in the brain. Sodium bicarbonate is more safely delivered...

Nutrition 101 What You Might Learn in Initial Sessions

A calorie is a measurement of the energy released when your body breaks down food, including carbohydrates, proteins, and fats. Your body needs a certain number of calories in order to survive and thrive. The more calories in a food, the more energy that food can give to your body. Under normal circumstances, if you eat more calories than you need for daily activities, your body stores the extra calories as fat and you'll gain weight if you eat fewer calories than your body needs, you'll lose weight.

Patient Counseling on Dietary Changes

Reducing intake of simple carbohydrates) to reach the outcome (improved HbA1c levels). Often, dietary advice involves the patient being told to do the outcome, such as lose some weight or improve A1c. Although important goals, these should not be confused with what action a patient can take. A patient cannot stand still and lose weight but can only change eating patterns and increase physical activity (behaviors). In communicating with patients, it is important to state not only the desired outcome and why (e.g., It is important to get your hemoglobin A1c below 7 so that you can reduce the chance that you will have complications from your diabetes, such as loss of vision or amputation ), but also to discuss how the patient might accomplish that outcome (e.g., Eating a healthy diet and increasing physical activity can improve A1c. Which of these would you like to talk about today ).

Depression Checklist Are You at Risk

Our strategy includes nourishing the body with foods that are high in complex carbohydrates and protein. These contain essential nutrients to feed your brain. Acupuncture, moxibustion, and herbal medicine have been effective in clearing the mind, restoring good sleep, and bringing energy and centeredness into your being. Suan Zao Ren, Bai Zi Ren, Mu Li, Long Gu, and Dan Shen are just a few of the herbs that may be used in your formula.

Issues Relating to Formal and Informal Research on Mood

Involving the most strict controls, the experiment would probably utilize a substance primarily composed of simple carbohydrates carefully proportioned for nutrient quality and quantity. The substance tested would not likely be a familiar candy bar, but instead something that could be better controlled. Less certain, however, would be exactly what constituents of the candy may be producing the effect. For instance, an effect from candy in general may be occurring because the carbohydrates increase concentrations of tryptophan and serotonin, or the mood effect may be due to a sudden increase in blood glucose and the subsequent insulin infusions that stabilize and reduce the glucose levels. Using the procedures outlined above makes these physiological influences more difficult to evaluate. Even though the question of the influential constituent is important scientifically, it is not essential to the more general question of how regularly eaten candy bars affect daily mood states. That...

Cyclodextrin Complexation Of Volatiles

Cyclodextrin molecules are modified carbohydrates that have been used for many years to modify the solubility properties of drug molecules by complexation. The cyclodextrin can also be applied to volatiles to protect them against the environmental hazards and thus prolong the shelf life of these compounds. Cyclodextrin complexation will also modify the volatility of the essential oils and prolong the bioactivity. The cyclodextrins will give a molecular encapsulation by the complexation reaction with volatile molecules. The complexation of the volatiles with cyclodextrin may improve the heat stability, improve the stability toward oxygen, and improve the stability against light (Szente, 1988). A significant lowering of the volatility has been observed for the complexation with essential oils (Risch and Reineccius, 1988). The complexation of essential oils by the use of cyclodextrins will also result in increased heat stability. This is in contrast with the stability of volatiles that...

Natural Products And Synthetic Polymers

Natural products are divided into particular classes of compound. These include carbohydrates, lipids, amino acids, peptides and proteins, and nucleic acids. Carbohydrates (or sugars) are poly-hydroxycarbonyl compounds that exist as monomers, dimers or polymers. Organic-soluble waxes, oils, fats and steroids are known as lipids, while the condensation of amino acids produces natural polyamides known as peptides and proteins. Nucleic acids (which include RNA and DNA) are natural polymers made up of sugars, heterocyclic nitrogen bases and phosphate groups. Synthetic (unnatural) polymers, which have had a tremendous impact on our day-to-day living, can be classified as chain-growth polymers (e.g. polyethylene) or step-growth polymers (e.g. polyamides or nylons). 11.1 Carbohydrates Carbohydrates are a class of naturally occurring polyhydroxylated aldehydes and ketones, which are commonly called sugars. Many, but not all, sugars have the empirical formula Ct(H20)v. Simple...

A62 The small intestine

The small intestine is concerned primarily with the absorption of sugars or carbohydrates and produces the related enzymes maltase, sucrase, and lactase. Although the nerve supply to the small intestine is both from the parasympathetic and sympathetic nervous systems, these nerves regulate motility or contractions of the small intestine (peristalsis) and have no role in the production of the digestive enzymes. The absorption of food takes place mainly in the small intestine. Amino acids and fats are also absorbed here.

Complement Activation By Immunoglobulins

Sensitized with mannan-binding lectin (MBL), were exposed to anti-E hemolysin antibodies. This led to twofold enhancement of lectin pathway hemolysis when E-M-MBL was coated with IgM or IgA and fourfold when coated with IgG (5). In-vitro studies have demonstrated the ability of MBL to bind to polymeric IgA in a dose-dependent manner this binding induced C4 and C3 cleavage upon addition of complement source (6). Certain patterns of IgG glycosilation (glycoforms) are associated with the lectin pathway of complement activation. There are two oligosaccharide chains in the Fc region of IgG molecules that have either 2 terminal galactose residues (G2 glycoform) one galactose and one N-acetylglucosamine (G1 glycoform) or 2 terminal N-acetylglucosamines (G0 glycoform). It is the last glycoform of IgG (G0), in which Fc carbohydrates terminate in N-acetylglucoasmine, that can activate complement via MBL (7). In rheumatoid arthritis, there is an increase of G0 glycoforms, thus enabling terminal...

Requirements Carbohydrate Protein Fluid Vitamin and Minerals

Adequate carbohydrate ingestion is required during and after exercise to replete maintain glycogen stores. Carbohydrate contains 4 kCal g 6-8 g kg of body mass are required daily. For a 70-kg (155-lb) athlete this is about 500 g day or about 2000 carbohydrate calories of a 3000 calorie day diet. Note this is significantly higher than for the sedentary. This is best consumed starches and fiber such as pasta, breads, or cereals containing whole grains. Timing is important Ideally carbohydrates should be consumed within the first 20-40 minutes after exercise, to accelerate glycogen repletion. A good guideline is 1.5 carbohydrate kg immediately after exercise followed by a second dose about 2 hours later, or about 100 g of carbohydrate for the 70-kg athlete. These can be easily accommodated in the daily requirement.

Perioperative Management of the Diabetic Surgical Patient

In patients with T1DM, withholding insulin leads to the development of ketosis, adding to the nutritional and electrolyte problems that often accompany surgical illness. In these individuals, it is important to provide a certain amount of insulin at all times, even during fasting. This is most easily done with the IV coadministration of 5 dextrose in water (100 to 200 mL hr) and R insulin (1 to 2 units hr) begun the evening before surgery. Ambient blood levels are maintained between 100 and 150 mg dL. Blood glucose is monitored every 1 to 2 hours before surgery and hourly during surgical anesthesia to optimize metabolic control. More commonly used methods, such as providing one half to two thirds of the usual intermediate insulin dose on the morning of surgery, may be adequate. However, this method results in a peak of insulin action, which will not necessarily coincide with a planned meal. In addition, insulin absorption from SC tissues may be altered during surgery because of...

Diagnostic Evaluation

Stern, there appear to be several important diagnoses. Inflammatory bowel disease (IBD), irritable bowel syndrome, traveler's diarrhea, pseudomembranous colitis, celiac disease, and giardiasis are certainly in the differential diagnosis. The history of iritis and low back pain makes the diagnosis of IBD a strong possibility. IBD, consisting of Crohn's disease and ulcerative colitis, is very common, with an annual incidence in the United States of approximately 3 to 10 new cases per 100,000 people. Extraintestinal inflammatory manifestations are common. Ocular manifestations occur in 5 of patients with IBD, and ankylosing spondylitis, in 5 to 10 . The most common extraintestinal manifestation is a peripheral, large-joint, asymmetric, nondeforming arthritis this occurs in 20 of patients with IBD. Mr. Stern does not have a history of this type of arthritis. Genetic disorders seem unlikely, inasmuch as the appearance of this patient's problem started at age 27 or 28....

Etiology and Epidemiology

Insulin-Dependent Diabetes Mellitus (Type I) Insulin-dependent DM is characterized by clinically acute onset, usually at an early age, lymphoid infiltration of the islets of Langerhans, reduction in the functioning and production of their betacells, reduction in the production and excretion of insulin, increases in islet cell antibodies, weight loss, thirst, frequent urination, and high levels of blood sugar. After the acute onset of type I diabetes, a clinical remission may occur in 25 to 100 percent of the reported cases for periods ranging from 1.8 to 15 months. After this initial period, all patients require insulin therapy to prevent severe symptoms and profound biochemical aberrations that can lead to ketosis, coma, and death. Non-Insulin-Dependent Diabetes (Type II) Between 90 and 95 percent of all individuals with diabetes have type II diabetes and are over the age of 35 years. In contrast to type I diabetes cases, there are many cases (up to 50 percent) that remain...

Benign Neonatal Familial and Nonfamilial Convulsions Benign idiopathic neonatal convulsions BINNC

In general, seizures respond poorly to anticonvulsant treatment, and polytherapy is usually required. Benzodiazepines and valproic acid are the most effective agents, although the former may precipitate tonic status. Sedation should be minimized because of the tendency for seizures to increase in sleep. Phenytoin and rectal diazepam are effective for serial tonic seizures and status epilepticus. Lamotrigine may be effective against atypical absence, myoclonic, and atonic seizures. Refractory cases may benefit from the ketogenic diet or corpus callosotomy, which reduces tonic and atonic seizures in some cases.

Glucose Metabolism Disorders Hypoglycemia

Although patients who present with encephalopathy may easily be diagnosed with hyperglycemia as the cause, diagnostic difficulty arises when encephalopathic patients present without a history of diabetes. Blood glucose determinations must be performed on all encephalopathic patients, and when they are shown to be hyperglycemic, DKA and NKHH, in addition to uremia, hepatic failure, toxin ingestion, starvation ketosis, alcoholic ketoacidosis, lactic acidosis and other causes of encephalopathy, must be excluded. A history of ethanol abuse and, typically, a lack of hyperglycemia helps differentiate alcoholic ketoacidosis. Evidence of renal dysfunction and the absence of ketones helps differentiate uremia, and starvation ketosis is not associated with hyperglycemia.

Blood Flow Of The Portal System

The liver is unique in that it receives both nutrient-rich deoxy-genated blood (portal vein) and oxygenated blood (hepatic arteries). The portal vein branches as it enters the liver, where its blood percolates around hepatocytes in tiny vascular channels known as sinusoids. Hepatocytes detoxify the blood, metabolize fats, carbohydrates, and drugs, and produce bile. The sinusoids receive deoxygenated blood from the portal veins (provide blood for metabolism and detoxification) and oxygenated blood from the hepatic arteries (provide oxygen for hepatocytes). Blood exits the sinusoids into a central vein, which empties into the hepatic veins and ultimately into the inferior vena cava, which passes through the diaphragm before entering the right atrium of the heart.

Overview of Glucose Metabolism

In the postprandial phase, hepatic glucose production is suppressed, with new glucose appearance primarily due to absorption of digested carbohydrates. Glucose absorption generally lasts for 2 to 5 hours after a meal, depending on the caloric content and composition of the meal. The tissues responsible for glucose utilization include those that require insulin and those that are insulin independent. The brain is the organ responsible for most of the insulin-independent glucose utilization in the fasting state, with erythrocytes and the renal medulla involved to a lesser extent.

Introduction To Aromatherapy Concepts

As an example, a whole orange differs from just the essential oil (extracted from the rind alone) as the water-soluble vitamins (thiamine, riboflavin, nicotinic acid, and vitamins C and A) are excluded, as are calcium, iron, proteins, carbohydrates, and water. Substantial differences in bioactivity are found in different fractions of plants, for example, the essential oils of Pelargonium species produced a consistent relaxation of the smooth muscle of the guinea pig in vitro, whereas the water-soluble extracts did not (Lis-Balchin, 2002b). Botanical misinterpretations are also common in many aromatherapy books, for example, geranium oil bioactivity is based on Herb Robert, a hardy Geranium species found widely in European hedgerows, whereas geranium oil is distilled from species of the South African genus Pelargonium (Lis-Balchin, 2002a).

Ascites In Pathophysiology In Book

Portal Vein Anatomy

The sinusoids transport both portal and arterial blood to the hepatocytes. The systemic blood delivered to the liver contains nutrients, drugs, and ingested toxins. The liver processes nutrients (carbohydrates, proteins, lipids, vitamins, and minerals) for either immediate use or for storage, while drugs and toxins are broken down through a variety of metabolic processes. Changes in hepatic blood flow can significantly alter metabolism. Processing of drugs eliminated by first-pass metabolism is reduced, extending the half-life. In the case of prodrugs that are activated by the liver, the time to therapeutic effect is delayed. The liver also processes metabolic waste products for

Subacute Presentation of Type 1 Diabetes

The management of type 1 diabetes will depend on the patient's age and the acuity of the diabetes at presentation. Since there is usually no family history of diabetes, or diabetic experience at home, and given the fragility of the new-onset diabetic state, many children or adolescents presenting with type 1 diabetes require hospitalization to initiate and teach glucose monitoring techniques and to begin insulin treatment. The indication for hospitalizing a newly diagnosed child who is not drifting into ketosis depends on the availability of outpatient educational resources and the clinical judgment that the patient can be closely monitored and the family appropriately advised while developing the capabilities of diabetic self-management.

Various Transporter Defects Hartnups Disease

At about age 3 months, a perfectly normal infant develops seizures--myoclonic, atypical absences, or unclassifiable--that are refractory to antiepileptic drugs. Developmental delay occurs the longer seizures are uncontrolled and the diagnosis is undiscovered, which can culminate in mental retardation and secondary microcephaly. The differential diagnosis includes any disease or condition causing refractory seizures in early infancy (see section on Menkes' disease). In this disorder, CSF glucose is 30 mg dl or lower, with a reduced CSF blood glucose ratio (about 0.33). CSF lactate is also low (0.97 mM L or less). EEGs and neuroimaging studies are normal. Treatment involves seizure control with a ketogenic diet, because the diet provides ketone bodies as an alternative source of fuel for brain metabolism. The prognosis for seizure control and normal development is excellent, with early diagnosis and treatment. It is likely that the defect becomes less consequential with age as the...

Does Excessive Protein Build Larger Muscles

In addition, anyone eating excessive protein will urinate more frequently because the breakdown of protein produces an increase in urea, a waste product in urine. You can imagine the inconvenience of running to the bathroom every 10 minutes, let alone your risk of becoming dehydrated. Furthermore, body builders who take tremendous amounts of protein tend to skimp on carbohydrates the key energy-providing ingredient for an optimal workout.

Niacin and Nicotinic Acid

Nicotinic acid deficiency was found to be the causative agent of pellagra in 1937, yet the name was changed to niacin in order to prevent confusion with the tobacco derivative, nicotine. Niacin includes both nicotinic acid and nicotinamide, which form the metabolically active nicotinamide adenine dinucleotide (NAD) and NAD phosphate (NADP), an end product of tryptophan metabolism. More than 200 enzymes are dependent on NAD and NADP to carry out oxidation and reduction reactions, and these enzymes are involved in the synthesis and breakdown of all carbohydrates, lipids, and amino acids. Although niacin is endogenously produced in humans, exogenous intake is required to prevent deficiency. Niacin is found in meats, liver, fish, legumes, peanuts, enriched bread, coffee, and tea.

Orthostatic Hypotension

Some patients may be helped by sleeping with the head of the bed elevated 15 to 30 cm (the reverse Trendelenburg position) to avoid supine hypertension and decrease nocturnal natriuresis and volume depletion. This maneuver alone may reduce postural hypotension in the morning. To reduce postprandial hypotension, patients should eat smaller, low-carbohydrate meals more frequently and drink strong coffee. Finally, custom-fitted elasticized garments (a Jobst or Barton-Carey leotard) may reduce venous pooling in the legs.

Table 305 Glycogenoses

Children affected with classic McArdle's disease (myophosphorylase deficiency) initially show decreased stamina and easy fatigability. Although onset usually occurs in childhood, neonatal presentations have been reported. Severe cramping pain, usually in the distal skeletal muscles, develops after exercise and is often associated with renal impairment. In adolescence and adulthood, patients may develop persistent weakness and moderate loss of muscle bulk. Patients with Hers' disease have no specific neurological or muscle findings but display varying degrees of growth retardation, hypoglycemia, ketosis, and hepatomegaly. In Tarui's disease, motor development is normal during the first decade, but decreased muscle exercise tolerance, myoglobulinuria, and easy fatigability develop in childhood. An unusual infantile syndrome characterized by limb weakness, seizures, cortical blindness, and corneal opacifications occurs microscopic studies reveal typical findings of neuron axonal...

General Characteristics

One explanation of the high frequency of type II DM among these populations is that they developed a highly efficient carbohydrate metabolism under traditional lifestyles of a feast and famine cycle. The thrifty mechanisms of carbohydrate metabolism, however, became detrimental with rapidly changing lifestyles associated with a decrease in physical activity, an increase in energy in the diet, a reduction of dietary fiber, an increase of refined carbohydrates, and an increase in psychosocial stress.

How Do You Know tf Youre Getting More Depressed The Mood Spiral

Getting on a regular bedtime wake-up routine, eating more protein and fewer carbohydrates, avoiding alcohol and street drugs, scheduling at least one contact each day with a person who could give him positive input, and taking breaks from work when he needed to. He also kept a thought record (see page 232) in which he recorded examples of self-blaming statements or overgeneralizations about his situation (for example, My life has never had any joy or fulfillment ). He also learned to counter these thoughts with more adaptive ones ( I'm going through a tough time. . . . I've dealt with this before and come out of it. , Depression is going to color the way I feel about things ).

Clinical manifestations

The classic picture of botulism is the acute onset of a flaccid descending paralysis with clear sensorium, no fever and no paresthesias. The rarity of foodborne and wound botulism makes them easily confused with other diseases. Routine laboratory studies, including the cereobrospinal fluid, are normal in botulism unless dehydration or starvation ketosis are present. EMG may demonstrate a defect in neuromuscular transmission, and the typical finding in food-borne and wound botulism is facilitation (potentiation) of the elicited muscle action potential at high frequency (50 Hz) stimulation. In infant botulism a characteristic pattern, known by the acronym BSAP (brief, small, abundant motor-unit action potentials), is present only in clinically weak muscles.

The Bodys Response to Stress

Dangers Stress

Hypothalamus, and pituitary gland are activated. The amygdala and hypothalamus are parts of the brain associated with fear, stress, and the integration of bodily functions. The pituitary gland, which is controlled by the hypothalamus, is located just beneath the brain and releases hormones needed by the body. As part of the stress response, ACTH, a hormone released from the pituitary gland activates the adrenal glands, which in turn release the stress hormones, epineph-rine and cortisol (see Figure 9-1). These hormones act throughout the body to prepare us for responsive action. Epinephrine increases heart rate and blood pressure to help the body meet the new demands. Cortisol increases blood sugar (glucose) to provide more fuel for the energy needed to deal with the stressor, and it does this by promoting the synthesis of glucose and by assisting in the metabolism of fat, protein, and carbohydrates that produce additional glucose. Chronic stress can affect many organ systems and...

Deterioration of Nutritional Status and Need for Support

Hospitalized patients, and especially surgery and trauma patients, often suffer from protein-calorie malnutrition (PCM). It is important that patients in the hospital receive adequate calories to meet energy needs and adequate protein to maintain cellular integrity. Caloric requirement can be estimated by a formula, as noted earlier. Protein should make up 1.5 to 2 g kg day of that caloric requirement. Specific amino acids (e.g., glutamine, arginine) may be especially important in catabolic states (e.g., cancer, burns). These amino acids are therefore called conditionally essential amino acids. Carbohydrates make up about 70 of the total caloric requirement and lipids about 30 .

Diseases Related to Infant Feeding

The literature on infant feeding is enormous (for comprehensive historical studies, see Wickes 1953 Cone 1976 Fildes 1986). By the nineteenth century, physicians in the United States and Britain tended to discourage wet nursing because of the adverse effects on the nurse's own infant, who was usually abandoned to foster care and the bottle. Efforts were directed toward increasing the safety of bottle feeding, perceived as the most important cause of high infant mortality. In 1867 Justus von Liebig, the renowned German chemist, marketed an infant food prepared on scientific principles (Drummond and Wilbraham 1958). It was not as perfect as he assumed (vitamins were then undreamed of), but it was the forerunner of an endless variety of proprietary infant foods. Many contained only powdered carbohydrates and thus, if not made up with milk and supplemented with other foods, could not begin to nourish an infant (for a discussion of interactions between physicians, infant food companies,...

Regression Require Commensurate Vascular Remodeling

Gained less or lost weight compared to controls (Fig. 1A). This was associated with significant and selective loss of adipose tissue, while the animals remained healthy (Rup-nick et al. 2002). Mice from other obesity models (Ay, Cpefat) and wild-type C57BL 6 mice fed a high-fat diet also lost weight with TNP-470 (Fig. 1B). Thus, adipose tissue growth depends on concomitant blood vessel growth.

Other Phenotypes in the Adrenergic Receptor Knockouts

The D KO had a very interesting increase in daily food and water intake, which might in part have been related to chronic hypotension (17). The B KO had a variety of abnormalities of glucose metabolism, including insulin resistance, increased plasma leptin, increased percentage body fat (with no change in body weight), and glucose intolerance and obesity with a high-fat diet (12). The authors offered an explanation involving increased parasympathetic activity caused by increased hypothalamic neuropeptide Y (12), and certainly further work in this area will be interesting and important. A current clinical paradigm is that a1-antagonists decrease insulin resistance, the opposite of the B KO.

Processing And Presentation Of Antigens

Antigens are substances, including proteins, carbohydrates and glycoproteins, which are capable of interacting with the products of a specific immune response. An antigen which is capable of eliciting a specific immune response by itself is called an immunogen. Foreign protein antigens must be degraded into small peptides and complexed with class I or class II MHC molecules in order to be recognized by a T cell this is termed antigen processing. Complexing with class I or II MHC molecules seems to be determined by the way in which the antigen enters the cell.

Overview Of Metabolism

Acetylcoenzyme A (acetyl-CoA) is central to understanding the role of the liver in metabolism. It may be considered as a major factor in metabolism, as it is the primary substrate in the tricarboxylic acid (TCA) cycle used to produce ATP by cell mitochondria. Acetyl-CoA is the end-point of the catabolic pathways which break down carbohydrates, proteins and fats. It is also used in the synthesis of other compounds in the body, including ketones, fatty acids and steroids. Therefore, in the sections below, one should appreciate the pivotal role of acetyl-CoA, as it is often the link between many diverse metabolic pathways (Fig. 22.3).

Gluconeogenesis Fig 224

Gluconeogenesis is defined as the production of glucose from non-carbohydrate sources. Maintenance of blood glucose is important, as it is the main fuel for the brain and red blood cells. In the fasted state, carbohydrate stores (in the form of liver glycogen) are depleted in 12-24 h. Therefore, alternative substrates are required for glucose synthesis by gluconeogenesis. The main substrates are amino acids (muscle breakdown), glycerol (triacylglyc-erol) and lactate (anaerobic metabolism in skeletal muscle and red blood cells). The liver is the main site of gluconeogenesis, but it also occurs in the renal cortex during prolonged starvation. Fat cannot be converted into glucose, but instead is used for ketone production, which the brain utilizes as an energy source in prolonged starvation.

Nutritional Deficiencies and Disorders

In North Africa where the child between 1 and 3 years old is weaned abruptly and then given a diet of carbohydrates familiar in family fare, the young may not be able to tolerate the change, which may then cause dyspepsia, infantile diarrhea, lowered resistance to infectious diseases, and kwashiorkor. Nomadic tribespeople of the Sahara south of the Atlas mountains, however, wean the infant over a 6-month period, introducing it gradually first to camel's milk and then to cereals.

Nutrition and Disease

Before this revolution, the peasantry, which comprised 98 percent of the European population, had subsisted on a high-carbohydrate diet ingested as bread, porridge, and beer, whether derived from barley, as in some parts of the north, or from rye and wheat. When a peasant's principal crop failed, he and his family might well starve. Moreover, even with optimal harvests, they very likely experienced severe protein deprivation. The agricultural revolution brought them not only greater yields, but a diversity of crops, including legumes and peas, which served as a protection against famine and provided more vegetable protein. These nutrients were to be of far-reaching nutritional consequence, for the peasant seems to have received little animal protein in the early Middle Ages.

Mouth and Pharynx

Multiple caries, especially of the upper incisors, are often an indication of milk caries, also known as nursing bottle caries. They are caused by the child's going to sleep with a bottle of milk or juice in the mouth. Cariogenic fluids such as milk or sweetened beverages that constantly bathe the teeth while the infant is asleep are the cause of nursing bottle carries. The interaction of Streptococcus mutans and other microorganisms in the mouth and fermentable carbohydrates results in acid demineralization of the susceptible tooth enamel. Untreated carious destruction progresses through the enamel, dentin, and pulp, producing periapical abscesses. The maxillary anterior teeth are the first to be affected. The mandibular teeth are the least affected. Figure 24-42A shows severe milk caries that necessitated removal of all the child's primary dentition. Always look for a small pimple in the alveolar ridge above a damaged tooth this is evidence of a periapical abscess and necessitates...

Nursing Bottle Caries Clinical Summary

The etiology of dental caries is multifactorial with an interplay between microflora (plaque colonized with Streptococcus mutans), substrate (fermentable carbohydrates from breast milk, formula, or juice), and host (saliva and teeth). Nursing or milk bottle caries results from prolonged and frequent night time breastfeeding or sleeping with a bottle containing milk or sugar-containing juices. The sugars are fermented by the bacteria in plaque, lowering the pH in the mouth and resulting in demineralization of the tooth enamel. The condition generally occurs before 18 months of age and is more prevalent in medically underserved children. Upper central incisors are most commonly involved. Dental referral is

Initial Treatment Insulin and Potassium

Management of DKA involves administration of insulin, water, and electrolytes safely to prevent marked fluid shifts into the brain and a precipitous drop in potassium, which would impair compensatory hyperventilation. Insulinization promptly blocks further liposis and shuts down ketogenesis. R insulin is given as an intravenous (IV) bolus of 0.1 U kg with the start of saline administration. Some suggest the initial bolus should be as much as 20 U. The bolus infusion is followed by a continuous infusion of 0.1 U kg hr, with hourly adjustments based on decline in serum glucose and reversal of acidosis. Low-dose insulin infusions are safe if the potassium value is monitored, and improving metabolic parameters should be apparent in 1 or 2 hours. Some patients may be remarkably resistant, and a significant bolus adjustment of up to 20 units may be necessary in 1 hour, with modification of the infusion concentration. The objective is not to decrease glucose precipitously but to turn off...

Initiating Insulin for Type 2 Diabetes

The classic setting for the use of insulin is in a newly diagnosed type 1 diabetic patient. However, insulin is more frequently used in the treatment of type 2 diabetes to compensate for the secretory defect that often progresses to a profound loss of insulin secretory reserve. This is suggested when FSG or HbA1c continue to rise despite the patient's best behavioral efforts and multiple oral drugs. A patient with type 2 diabetes can also present late in its course with marked hyperglycemia and even ketosis. In these patients, insulin treatment protocols used in type 1 diabetes are appropriate until the type 2 pattern of glucose homeostasis is recognized. In most patients, convenience insulins such as human or synthetic 70 30 or 75 25 combinations can be used for several days until the effects of behavioral measures and oral agents kick in. Dosage is usually from 0.2 to 0.5

Maturity Onset Diabetes of Young

Genetic defects of beta-cell function involve genes coding for hepatic transcription factors and glucokinase. In the MODY variant, hyperglycemia is observed during childhood or adolescence and is caused by a diminution in beta-cell secretion without impairment in insulin action. The genetic disorders are autosomal dominant, and the glucokinase defect impairs the conversion of glucose to glucose-6-phosphate, which is involved in insulin secretion. This glucokinase dysfunction causes a loss of the beta-cell glucose sensor. The resulting diabetes is generally not prone to ketosis. Many patients with milder forms of diabetes treated as type 1 eventually are found to have similar genetic defects.

Insulindependent diabetes mellitus

In healthy children, insulin levels decrease with exercise so that glucose can be liberated from stores in the liver and blood levels are maintained despite an increase in glucose uptake into the exercising muscle. Children suffering from insulin-dependent (type 1) diabetes mellitus have to inject insulin into the subcutaneous fat tissue. In consequence, insulin is liberated at a constant rate from the subcutaneous injection site, irrespective of glucose demand. Since insulin sensitivity increases during and following exercise, these children are at a high risk of experiencing severe hypoglycemia with exercise, resulting in a loss of consciousness or epileptic seizures. Low blood glucose levels have been described for up to 24 h following exercise in patients with insulin-dependent diabetes. In a survey of parents whose children had suffered from severe hypoglycemia, many parents blamed preceding exercise as trigger. Children should therefore be advised to measure blood glucose before...

The Insulin Connection

Until recently, carbohydrates were ignored as a health issue. They are at least as important, and probably more so, than fats in determining weight and cardiovascular fitness. The key to carbohydrates' influence is insulin. Insulin is a hormone secreted by the pancreas in response to

Exercise and weight regulation Effect of exercise on body weight

Of carbohydrates, fat and protein equals the intake of these nutrients. It has therefore been concluded that the quotient between the intake of carbohydrates and fat (described as the food quotient, FQ, i.e. the ratio of carbon dioxide produced to oxygen utilized for the oxidation of the food) over the long term must equal the average RQ over 24 h (RQ-24 h) for the individual to maintain weight balance 59,60 . Most individuals are in weight balance, where their weight only fluctuates by 1-2 . If unusually little food is taken in on a particular day, the RQ will be lowered due to inhibition of glucose oxidation, and fat oxidation will be increased to cover the negative energy balance. Conversely, if more food than usual is taken in during one day, carbohydrate oxidation will be increased (and fat consumption passively decreased to achieve energy balance that day) 59 . Thus, if the intake decreases it will be covered by stored fat thereafter all of the lost fat is replenished due to an...

Energy sources during exercise in the trained state

One factor counteracting the low fat combustion at high exercise intensities is the effect of training. It has been convincingly shown that, at a certain exercise intensity, a trained individual uses more fat than an untrained individual. This effect is quite strong and occurs after relatively short periods of training. One group of subjects was studied after 5 and 31 days of training for 2 h daily at a moderately high exercise intensity (60 of the pretraining Vo2max) 48 . Following 5 days of training, the total fat oxidation at this intensity had increased by i0 and after 3i days of training, the increase was as high as 70 . The oxidation of carbohydrates during the exercise bout showed the opposite pattern. It is therefore obvious that a good physical fitness level makes it much easier to maintain a high degree of fat combustion during intense exercise 49 .

Energy sources during exercise in the postabsorptive state

During exercise, the energy consumption may be increased by 20-fold. The primary factor determining whether carbohydrates or fat are preferentially used during exercise is the exercise intensity, the proportion of energy derived from carbohydrates growing progressively larger with increasing intensity. At a moderate exercise level of 100 W, demanding an oxygen uptake of around 1.5 L min, equalling an energy expenditure of 1800 kJ h, the proportions might typically change to 60 carbohydrates and 40 fat. In this situation, the demand for carbohydrates (65 g glucose h, i.e. 1080 kJ) is met by glycogenolysis (around 40-45 g h) and glucose uptake (around 20 g h), whereas the demand for fat is met by lipolysis in adipose tissue and muscle, supplying 18 g fatty acids (i.e. 720 kJ). Under normal circumstances, protein is not an important metabolic fuel during exercise, and it is considered unlikely that, even during prolonged exercise, protein oxidation can cover more than 10 of the energy...

Energy sources at rest

At rest, under postabsorptive conditions, fatty acids constitute the primary energy source, accounting for approximately 60 of energy requirements, leaving about 20 for carbohydrates and proteins, respectively. Postabsorptive conditions are said to be present when no nutrients are entering the blood from the intestinal tract. The energy liberated per gram of nutrient combusted is 17 kJ for carbohydrates and proteins and 39 kJ for fat. Therefore, the demand for fat combustion at rest can be covered by the adipose tissue liberating 5 g of fatty acids per hour, of which 1.5 g is taken up by the liver and 2 g by skeletal muscle. The carbohydrates are provided by the liver, which releases 7.5 g h of glucose, of which 4.5 g is derived from glycogenolysis and 3 g from gluconeogenesis. This covers mainly the 6 g h of glucose which is used Absorptive conditions prevail for several hours following each meal, with most nutrients being taken up by the body during the first 2-3 h. If it is assumed...

Aerobic processes of ATP generation

The ultimate process of ATP formation is oxidative phosphorylation during which various substrates are oxidized with oxygen in the mitochondrion. The process is rather complex and will be described only briefly. The fuels for the aerobic processes are mainly pyruvate (derived from carbohydrates) and fatty acids (derived from triglycerides). These fuels are degraded by separate routes to acetyl-CoA within the mitochondrion. The acetyl group of acetyl-CoA is catabolized to CO2 in the TCA cycle (tricarboxylic acid cycle) by which electrons are transferred from the substrates to coenzymes (mainly NAD+). The electrons are transferred from the reduced coenzyme (NADH) to the electron transport chain with oxygen being the final electron acceptor. When electrons pass through the electron transport chain their energy level decreases and part of the energy is used to transfer protons through the mitochondrial membrane. When protons diffuse back through the membrane protein (ATP synthase) ADP is...

How Does Alcohol Reduce the Risk of Heart Disease

New studies are beginning to show that moderate to light alcohol consumption (one drink a day, six days a week) may have a protective effect on the heart. This explains why some wine-consuming European countries experience relatively lower rates of coronary artery disease despite high-fat diets.

Nutrition for a Healthy Heart

Any appreciable amount, only a few hundred grams as glycogen in the liver and muscles. Most consumed carbohydrates (sugars) are converted under the influence of insulin into fat and are stored throughout the body, often in aesthetically undesirable places. In fact, sugar is directly responsible for most cholesterol. Only 40 percent of ingested cholesterol is absorbed from the gastrointestinal tract. Most cholesterol is actually manufactured by the liver under the influence of insulin. The higher the insulin level, the more cholesterol is manufactured. What makes insulin levels rise Sugar A healthy diet must address everything fats (triglycerides) carbohydrates (sugars) protein (amino acids) and fiber. Many people are aware of the harmful effects of too much fat and have taken appropriate steps. Now, people must look carefully at carbohydrate consumption. Attention to correct carbohydrates will involve not only sugar, but also fiber, which has been shown to have a beneficial effect on...

Progressive Infantile Poliodystrophy Alpers Disease

A trial of pyridoxine, 50 mg twice a day orally can be done to rule out pyridoxine- dependent deficient seizures. If the serum and CSF glycine levels are elevated, the glycine cleavage enzyme activity should be assessed by liver biopsy in a laboratory qualified to do this test and treatment should be started with dextromethorphan, leucovorin, and sodium benzoate for nonketotic hyperglycinemia. In symptomatic treatment of the seizures, valproic acid should be avoided, because the risk of accelerating the course and a resultant fatal toxic hepatitis is very high. Other treatments of refractory, non- surgically treatable epilepsy at this age, such as adrenocorticotropic hormone or prednisone, ketogenic diet, and intravenous IgG, are unproven and may be harmful.

Myoclonic Epilepsy and Ragged Red Fibers Syndrome

Seizures can be symptomatically treated with valproate (watching for carnitine deficiency) and clonazepam. There is a dearth of data as to whether measures for refractory myoclonic epilepsy--ketogenic diet, adrenocorticotropic hormone or corticosteroids, or L-5-hydroxytryptophan plus carbidopa--have been effective. Corticosteroids have been used for the myopathy and improvement has been noted,

How to Use This Book

Part 1, Time for a Nutrition Tune-Up, clears up the confusion on the fundamentals of food. This section dissects the dietary guidelines and offers simple strategies to incorporate the five food groups into your life. You'll also get the inside scoop on simple to complex carbohydrates, the power of protein, and the relationship between excessive fat intake and heart disease. In addition, you'll examine the facts on fiber and salt, plus become well versed on the vital vitamins and minerals that your body requires.


This first part of the book proves that eating healthy does not need to be complicated or restrictive. In fact, it is quite the contrary. This section unravels the colorful Food Guide Pyramid and provides the inside scoop on carbohydrates, protein, fat, fiber, and salt. After grasping these fundamentals of food, you'll be ready to read further into the book and learn the specifics about everything you never understood or realized.


The process of digestion begins in the mouth. The action of the teeth and tongue during chewing breaks food into small, soft pieces for swallowing, while substances in the saliva start to break down carbohydrates in the food. When you swallow, the tongue pushes the mixture of food and saliva, known as a bolus, down the throat into the oesophagus. At the same time, the soft palate closes off the nasal cavity, and the epiglottis, a small flap of cartilage at the back of the tongue, moves to close off the larynx.

Composition of milk

Reflecting mainly the nutritional and physiological requirements of the neonate, the composition of milk, and even the profile of constituents therein, changes markedly during lactation. The changes are most marked during the first few days post-partum, especially in the immunoglobulin fraction of proteins. For marsupials, the milk changes from a high-carbohydrate (mainly oligosaccharides) secretion to a high-fat secretion when the neonate begins to leave the pouch, a time that corresponds roughly to the birth of eutherians. The composition of milk remains relatively constant during mid-lactation but changes considerably in late lactation, reflecting the involution of the mammary gland tissue and the greater influx of blood constituents.

Other Addictions

Although this is a book about drugs and how people become hooked on drugs, it is also about all of our appetites therefore, it can help us understand other potential addictions such as eating and gambling. For example, if someone overeats, craves carbohydrates every day, and has withdrawal symptoms when he stops cold turkey, then he may have a problem with carbohydrates. If such a person seeks help, then this book can help with understanding the problem and the needs for treatment. More is said later about food, gambling, and sexual drives.

Dental Disease

First, like bone, teeth and their supporting tissues react to different disease conditions in similar ways, so that one may be unable to attribute an abnormal condition to a specific disease. Second, the methodology for analyzing these dental pathologies is inexact, often making comparisons among observations hazardous. For these reasons, we will examine in detail only enamel hypoplasia, a condition that has been carefully studied (e.g., Goodman, Martin, and Armelagos 1984 Molnar and Molnar 1985 Rose, Condon, and Goodman 1985 Goodman 1991). Although there is a considerable body of data on caries, methodological problems hinder interpretation. Basically, variation in caries rate appears to be attributable to two dietary factors presence of carbohydrates and sugar, and presence of gritty food. (Gritty substances remove the crevices in the dental crown, thereby eliminating the locations for bacterial activity.)


With regard to possible roles of diet in carcinogenesis, both low-fiber and high-fat diets have been proposed to be pathogenetic for colorectal cancer. The best evidence now indicates a carcinogenic effect of increased fat consumption, particularly in women. The predominant hypothesis for this association is Higher fat consumption increases excretion of bile acids and growth of colonic bacteria therefore, the conversion of bile acids into carcinogenic substances by bacterial metabolism is facilitated.


In addition to providing specific nutrients, food also provides energy. The energy content of the diet is derived solely from the fats, proteins and carbohydrates, and the proportion of these energy-producing nutrients in the diet will determine its energy content (also referred to as the energy density). energy theoretically available from it is lost in meal-induced heat. Meal-induced heat is the metabolic heat 'wasted' in the digestion, absorption and utilization of the protein. Fat and carbohydrates are better sources of energy for performance.


Normal exercise utilizes the oxidation of carbohydrates and fats to generate ATP for muscle contractions. Reflex actions adjust ventilation and circulatory requirements to deliver oxygen and remove carbon dioxide. The maximum oxygen consumption serves as a good measure of exercise capacity and fitness. Low cardiovascular fitness reduces the maximal capacity to deliver fuels to working muscle and reduces the mass of mitochondria and the enzymatic machinery needed for high rates of oxidative phosphorylation. Patients with an acute debilitating neurologic illness become decon-ditioned rather quickly and their tolerance for exercise drops off.


Gastritis patients should have a short period of gut rest, with or without parenteral fluids, depending on the frequency and severity of the vomiting. When enteral feeding recommences the chosen diet should be bland, low fat and highly digestible, i.e. low in fibre. Low-fat foods are recommended because high-fat diets delay gastric emptying and so remain for longer in the stomach increasing the chances of the vomiting persisting.


Protein levels for diabetic dogs should be approximately 15-25 on a dry matter basis (DMB) and more than 28 DMB for cats. Recent advances in the management of feline diabetes have involved feeding high-protein (50 DMB), low-carbohydrate foods. These have been shown to increase tissue sensitivity to insulin and reduce cholesterol, leading to improved glycaemic control.

Soluble carbohydrate

The composition and quantity of dietary carbohydrates for the management of diabetes mellitus in humans is controversial. This has also been an area of recent research in small-animal clinical nutrition but as yet absolute recommendations have not been made. Diabetic cats should not be fed diets containing fructose. Fructose is often found in commercial semi-moist foods, as a humectant and as high-fructose corn syrup. Cats do not metabolize fructose, causing fructose intolerance, polyuria and potential renal damage. Some nutritionists believe that high carbohydrate diets may be partly responsible for the onset of diabetes mellitus in cats. As a rule, soluble carbohydrates should make up no more than 30 of the total dietary carbohydrate level.

Food type

Shown that soft, moist foods (those marketed as individual meal-sized portions, usually in foil packets) have a hyper-glycaemic effect compared to dry foods because they contain increased levels of simple carbohydrates (sugars) and the ingredients used as humectants (such as propylene


Dogs do not have an essential requirement for carbohydrate in the diet. However, most dogs have a remarkable ability to utilize carbohydrates for energy so they are often used by pet food manufacturers as a primary source of dietary energy. Dogs with cancer develop high levels of insulin and lactate, as the tumour uses glucose and produces lactate. High-carbohydrate foods should be avoided in dogs with cancer since they would add to this hyperinsulinaemia and hyper-lactataemia. Carbohydrates should comprise less than 25 of the food's dry matter.

Eating and drinking

Carbohydrates Malnutrition is a pathological state which results from a relative or absolute deficiency or excess of one or more essential nutrients. As protein or carbohydrates are used in the largest quantities, they are usually the deficient nutrients. This is referred to as protein-energy malnutrition or PEM.


Fat in order to obtain the same energy intake. Finally, the so-called nutritious and recommended carbohydrates, which also contribute vitamins, minerals and dietary fiber (starch-rich carbohydrates and fruit), are characterized by a large volume and water content. This type of carbohydrate is therefore much less energy dense than fat, which means that a larger volume of food intake is needed in order to obtain the same energy intake on a carbohydrate-rich diet than on a fat-rich diet. An athlete may therefore find that satiety occurs before the meal is finished and consequently that their intake of energy and carbohydrate is not adequate. Evidence of this also comes from the numerous From Table 2.4.5 it can be calculated that you have to eat i.i kg bread (23 slices of rye bread or 28 slices of wholemeal bread), 2.2 kg boiled rice or 4.3 kg apples, or drink 5-6L of juice every day in order to obtain 560 g carbohydrates per day. The volume problem of a very carbohydrate-rich diet can be...

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