Lect 23

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Alcohol Alcohol drug interactions Effects on brain Symptoms of cirrhosis Caffeine Recap of last lecture


#23 Outline for today Alternative sweeteners diet sodas, Hi-energy drinks Blood sugar levels Trans fatty acids, fats, lipids Next time: more on fats

Artificial sweeteners: 

Artificial sweeteners The FDA has approved five sugar substitutes: Aspartame, Saccharin, Acesuflame K, Neotame, and sucralose. The first three are widely used throughout the World. Aspartame is a very common sweetener that is found in both Equal and Nutrasweet. It is 180 times sweeter than sugar, but it is not chemically stable and is destroyed during cooking. (AspPheMe) (Basically safe, in spite of many web pages devoted to it being responsible for all ills)


Saccharin, most commonly known as Sweet ’N Low, is 300 times sweeter than sugar, and its sweetening powers are not destroyed by cooking. The FDA tried unsuccessfully to ban the additive due to research studies that linked it with bladder cancer in rats. There are no studies linking it to cancer in humans. Acesuflame K, found in Sunnette and Sweet, is 200 times sweeter than sugar, and can withstand high cooking temperatures. It has been approved by the FDA and has not been associated with cancer or any other disease


Another less common sweetener is Neotame (a derivative of aspartame); it has been approved by the FDA. It is 5000 times sweeter than sugar, is heat stable and can be used for cooking. It does contain phenylalanine in very small amounts. The manufacturers claim that the levels are so low that it is safe for people with PKU. Sucralose, (Splenda), is FDA approved. It is the only sweetener actually derived from sugar. It is 600 times sweeter than sugar, is stable for cooking, and is not known to produce any health risks. New on the mkt.


Three atoms of chlorine replace three hydroxyl groups on the sugar molecule. Sucralose tastes like sugar. The exceptional stability of sucralose allows both food manufacturers and consumers to use it virtually anywhere sugar is used, including cooking and baking. Sucralose is not utilized for energy in the body because it is not broken down like sucrose. Most is excreted directly. Sucralose has been extensively tested in more than 100 studies during a 20-year period and found to be a safe and remarkably inert ingredient. Sucralose


Sodas are sweetened, acidic, often caffeinated carbonated drinks.  There is "regular" pop that is sweetened with different kinds of sugar sweeteners and "diet" pop that is sweetened with artificial sweeteners.   Double trouble for teeth.  It's not just sugar that's bad for teeth, but the acids included in many popular drinks weaken the enamel and make teeth more prone to caries. The pH of regular and diet pops ranges from 2.47-3.35. Sodas


The average American today drinks over 600 servings of soda a year People who drink 3 or more sugary sodas daily have 62% more dental decay, fillings and tooth loss! The average American drinks more than 53 gallons of carbonated soft drinks each year, more than any other beverage, including milk, beer, coffee or water. Mountain Dew-20 oz is the worst pop, it contains 19 tsps of sugar and 93 milligrams of caffeine.......nearly equivalent to adult dose of NoDoz.

Too much soda?: 

Too much soda? Potential health problems associated with high intake of sweetened drinks are 1) overweight or obesity attributable to additional calories in the diet; 2) displacement of milk consumption, resulting in calcium deficiency with an attendant risk of osteoporosis and fractures; and 3) dental caries and potential enamel erosion.

Diet Soda: 

Diet Soda Drinking carbonated soft drinks regularly can contribute to the erosion of tooth enamel surfaces. Soft drinks, which contain sticky sugars that break down into acids, adhere easily to tooth surfaces.  These acids can soften tooth substance and promote formation of plaque, which erodes the enamel.  Enamel breakdown leads to cavities. 

Product Acid Sugar per 12 oz: 

Product Acid Sugar per 12 oz Diet Coke 3.39 0.0 Mountain Dew 3.22 11.0 tsp. Gatorade 2.95 3.3 tsp Coke Classic 2.63 9.3 tsp. Pepsi 2.49 9.8 tsp. Sprite 3.42 9.0 Diet 7-Up 3.67 0.0 Diet Dr. Pepper 3.41 0.0 Surge 3.02 10.0 Gatorade 2.95 3.3 Hawaiian Fruit Punch 2.82 10.2 Orange Minute Maid 2.80 11.2 Dr. Pepper 2.92 9.5 (OSHA rules preclude pouring these down the drain!!)

Energy Drinks : 

Energy Drinks Energy drinks are beverages loaded with caffeine, sugar, and other ingredients such as ginseng, taurine, guarana, and B-complex vitamins. Some energy drinks, such as Extreme Ripped Force, 4m energizer, and Xtreme NRG, contain ephedrine. One energy drink, Hansen Beverage Company's Hard E, contains 5 percent alcohol. Red Bull, originating in Austria, controls nearly two-thirds of the energy drink market in the United States, earning $300 million in 2002 and $1.2 billion worldwide

Adverse Effects : 

Adverse Effects Energy drinks can become dangerous when taken with alcohol. Adverse effects include dehydration, insomnia, headaches, nervousness, nosebleeds, and vomiting. Reports claim that energy drinks have caused even more severe reactions, such as seizure, heart arrhythmia, and death. The stimulating effect of energy drinks is deceiving, causing people to feel less intoxicated than they actually are and making it harder for bartenders to determine whether their patrons should no longer be served. As a result, people may be more inclined to drive while impaired.


Suspected deaths linked to energy drinks have been reported in Australia and Ireland. Three people died in Sweden after drinking Red Bull: two had mixed Red Bull with alcohol, and the third drank it after an exercise session. There is debate regarding whether the drinks caused these deaths. Norway, Denmark and France, however, sell Red Bull only in pharmacies because of its high level of caffeine. The Swedish National Food Administration recommended that Red Bull not be mixed with alcohol or consumed after exercise. The U.S. FDA took note of Sweden's advisement, but commented it cannot regulate imported drinks or herbal supplements.

Blood sugar levels: 

Blood sugar levels Normal fasting = 70 to 110 mg/dL Note: mg/dL = milligrams per deciliter Even after you have eaten, however, your glucose should be below 180.  Above 180 is termed hyperglycemia Concentrations of less than about 30 mg/dL or greater than about 300 mg/dL can produce confusion or unconsciousness Diabetes mellitus -- fasting blood glucose of greater than 126 mg/dL Impaired fasting glucose -- 110 to 126 mg/dL -- a prediabetic state


The "gold standard" for diagnosing diabetes is an elevated blood sugar level after an overnight fast (not eating anything after midnight). A value above 140 mg/dl on at least two occasions typically means a person has diabetes. Normal people have fasting sugar levels that generally run between 70-110 mg/dl

Glucose tolerance test: 

Glucose tolerance test The person being tested starts the test in a fasting state (having no food or drink except water for at least 10 hours but not greater than 16 hours). An initial blood sugar reading is taken and then the person is given a "glucola" bottle with a high amount of sugar in it (75 grams of glucose). The person then has their blood tested again 30 minutes, 1 hour, 2 hours and 3 hours after drinking the high glucose drink. A person is said to have a normal response when the 2-hour glucose level is less than or equal to 110 mg/dl. A person has diabetes when oral glucose tolerance tests show that the blood glucose level at 2 hours is equal to or more than 200 mg/dl. 

Regulation of blood sugar levels: 

Regulation of blood sugar levels Insulin and glucagon are the hormones involved : secreted from the pancreas Insulin is normally secreted by the beta cells (a type of islet cells) of the pancreas.  The stimulus for insulin secretion is a HIGH blood glucose. Although there is always a low level of insulin secreted by the pancreas, the amount secreted into the blood increases as the blood glucose rises.  Similarly, as blood glucose falls, the amount of insulin secreted by the pancreatic islets goes down. 


Glucagon is secreted by the alpha cells of the pancreatic islets in much the same manner as insulin...except in the opposite direction.   If blood glucose is high, then no glucagon is secreted.  When blood glucose goes LOW, however, (such as between meals, and during exercise), more and more glucagon is secreted.  Like insulin, glucagon has an effect on many cells of the body, but most notably the liver.  The effect of glucagon is to make the liver release the glucose it has stored in its cells into the blood stream, with the net effect of increasing blood glucose. 


Greater than normal levels (hyperglycemia) may indicate: Acromegaly (very rare) Cushing's syndrome (rare) Diabetes mellitus Prediabetic state Hyperthyroidism Pancreatic cancer Pancreatitis Insufficient amount of insulin Excessive food intake


Lower than normal levels (hypoglycemia) may indicate: Hypopituitarism Hypothyroidism Insulinoma (very rare) Injection of too much insulin Insufficient dietary intake


Hypoglycemia occurs when your body's blood sugar, or glucose, is abnormally low. Hypoglycemia is relatively common in diabetics. It occurs when too much insulin or oral antidiabetic medication is taken, not enough food is eaten, or from a sudden increase in the amount of exercise without an increase in food intake. Sometimes the cause of hypoglycemia is unknown (idiopathic). In these cases, people who are not diabetic and who do not have another known causes of hypoglycemia experience these symptoms. Hypoglycemia can occur because of an insulin-secreting tumor of the pancreas, liver disease, or as a response to the ingestion of alcohol. It affects approximately 1 out of every 1,000 people.


Fatigue General discomfort, uneasiness, or ill feeling (malaise) Nervousness Irritability, or even aggression Trembling Headache Hunger Cold sweats Rapid heart rate Blurry or double vision Confusion Convulsions Coma Excessive sweating Sleeping difficulty Paleness Muscle pain Memory loss Palpitations, or feeling your heartbeat (heartbeat sensations) Hallucinations Fainting Different size pupils Dizziness Decreased consciousness Symptoms

Hypoglycemia - Treatment   : 

Hypoglycemia - Treatment    A snack or drink containing sugar will raise the blood-glucose level If the person's blood-sugar levels are so low that he/she becomes unconscious or unable to swallow, this is called insulin shock, and emergency medical treatment is needed. An injection of glucose solution or the hormone glucagon will be given immediately. In the longer term, you may need to modify your diet so that you get glucose into your body more evenly throughout the day. This may prevent further hypoglycemic episodes. Small, frequent meals with complex carbohydrates, fiber, and fat; and avoiding simple sugars, alcohol, and fruit juice are the type of dietary modifications that may be recommended. You should also eat meals at regular intervals, and balance extra exercise with extra food.


Diabetes Diabetes is a very common disease, affecting about 2% of the general population, that results from insulin deficiency or insensitivity by the body to the level of insulin present.

Syndrome X or Insulin Resistance Syndrome : 

Syndrome X or Insulin Resistance Syndrome Insulin resistance is a reduced sensitivity in the tissues of the body to the action of insuln. Abnormalities in glucose and lipid metabolism, obesity, and high blood pressure


When insulin resistance, or reduced insulin sensistivy, exists, the body attempts to overcome this resistance by secreting more insulin from the pancreas. This compensatory state of hyperinsulinemia (high insulin levels in the blood) is felt to be a marker for the syndrome.

People who may be at risk for the insulin resistance syndrome: 

People who may be at risk for the insulin resistance syndrome those who are overweight, those who have a parent or sibling with Type II diabetes, women who had diabetes which occurred during pregnancy.


Many adults have some insulin resistance; most are able to produce enough insulin to maintain non-diabetic glucose levels. Some of these individuals will go on to develop overt type 2 diabetes, however the majority will not develop diabetes, but are still at significant increased risk for heart attack or stroke and other diseases. Over 80% of the 16 million Americans who have type 2 diabetes are insulin resistant. One in ten women have polycystic ovary syndrome, placing them at high risk for cardiovascular disease and type 2 diabetes

FATS, trans fatty acids : 

FATS, trans fatty acids Atherosclerosis

Saturated Fatty Acid Structure: 

Saturated Fatty Acid Structure omega end alpha end H H H H H H H H H H H H H H H H H O H-C--C--C--C--C--C--C--C--C--C--C--C--C--C--C--C--C-C-OH H H H H H H H H H H H H H H H H H

Monounsaturated Fatty Acid Structure: 

Monounsaturated Fatty Acid Structure omega end alpha end One double bond H H H H H H H H H H H H H H H O H-C--C--C--C--C--C--C--C--C=C--C--C--C--C--C--C--C--C-OH H H H H H H H H H H H H H H H H H

Polyunsaturated Fatty Acid Structure: 

Polyunsaturated Fatty Acid Structure omega end alpha end > 2 double bonds H H H H H H H H H H H H H O H-C--C--C--C--C--C=C--C--C=C--C--C--C--C--C--C--C--C-OH H H H H H H H H H H H H H H H H H

Chain Length of Fatty Acids: 

Chain Length of Fatty Acids Long chain FA > 12 Carbons Medium chain FA 6 - 10 Carbons Short chain FA < 6 Carbons

Essential Fatty Acids: 

Essential Fatty Acids Linoleic (w-6) and a-linolenic (w-3) Body can only make double bonds after the 9th carbon from the omega end Needed for immune function, vision, cell membrane, and production of hormone-like compounds

Essential Fatty Acid- Omega-3 (alpha-linolenic acid): 

Essential Fatty Acid- Omega-3 (alpha-linolenic acid) omega end alpha end 1st double bond is located on the 3rd carbon from the omega end H H H H H H H H H H H H H H H H H O H-C--C--C=C--C--C =C--C--C=C--C--C--C--C--C--C--C--C-OH H H H H H H H H H H H

Omega-3 Fatty Acid: 

Omega-3 Fatty Acid Primarily from fish oil Also found in canola or soybean oil Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are related Metabolized to form eicosanoids Recommend intake of ~2 servings of fish per week

Essential Fatty Acid- Omega-6 (alpha-linoleic acid): 

Essential Fatty Acid- Omega-6 (alpha-linoleic acid) omega end alpha end 1st double bond is located on the 6th carbon from the omega end H H H H H H H H H H H H H O H-C--C--C--C-- C--C =C--C--C=C--C--C--C--C--C--C--C--C-OH H H H H H H H H H H H H H H H H H

Omega-6 Fatty Acid: 

Omega-6 Fatty Acid Found in vegetable oils Only need ~ 1 tablespoon a day Arachidonic acid can be made from omega-6 Metabolized to form eicosanoids


Eicosanoids A group of hormone-like compounds Regulate blood pressure, childbirth, clotting, immune responses, inflammatory responses, & stomach secretions

Eicosanoids Have Different Effects: 

Eicosanoids Have Different Effects Omega-6 eicosanoids; Archidonic acid increase blood clotting increase inflammatory responses Omega-3 eicosanoids, DHA, EPA decrease blood clotting reduce heart attack excess may cause hemorrhagic stroke Eicosanoid has different effect on different tissues

Signs and Symptoms of Essential Fatty Acids Deficiency: 

Signs and Symptoms of Essential Fatty Acids Deficiency Flaky, itchy skin Diarrhea Infections Retarded growth and wound healing Anemia

Hydrogenation of Fatty Acids: 

Hydrogenation of Fatty Acids Process used to solidify an oil Addition of H to C=C double bonds Formation of trans fatty acid


Rancidity Decomposed oils Breakdown of the C=C double bonds by ultraviolet rays, O2 Yields unpleasant odor, flavor, and sickness when consumed PUFA more susceptible Limits shelf life

Prevention of Rancidity: 

Prevention of Rancidity Hydrogenation Addition of vitamin E Addition of Butylated hydroxyanisol (BHA) and Butylated hydroxytolune (BHT)

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