This discussion assesses your ability to clarify the role of each legally mandated attendee on the Individualized Education Program team. This assessment also supports your achievement of Course Learning Outcome….
Compare and contrast the two major forms of diabetes–Type 1 and Type 2
Essay Questions: can u pls finish it in 2.5 hours I just need 2-3 paragraphs thank you. PLS HELP ME. PLS READ FIRST PART CAREFULLY THANK YOU SO MUCH Pick ONE of the essay options listed below as your required midterm essay. It is recommended that you prepare your answer, in a Word document, then copy/paste it into the essay window in the exam. YOUR FIRST TWO REFERENCES FOR AN ESSAY MUST BE 1) YOUR TEXT, AND 2) THE LECTURE NOTES. YOU MUST CITE PAGE NUMBERS USED, THE LECTURE NOTES, OR ANY OUTSIDE RESOURCES YOU USE. YOU MAY USE ONE OUTSIDE REFERENCE. FAILURE TO LIST YOUR REFERENCES WILL RESULT IN POINTS BEING DEDUCTED FROM YOUR ESSAY SCORE. AN ESSAY THAT IS COPIED/PLAGIARIZED FROM ANOTHER SOURCE (OR ESSAYS THAT ARE “SHARED” BETWEEN STUDENTS) WILL RECEIVE A GRADE OF ZERO! Your essay should be in the range of 2-3 paragraphs in length. I expect all essays to be written using standard grammar and correct spelling–failure to make your essay readable may result in point deductions from your essay score. ESSAY OPTIONS: PICK ONE OPTION FROM THOSE GIVEN BELOW TO ANSWER ON THE MIDTERM EXAM: 1. Compare and contrast the two major forms of diabetes–Type 1 and Type 2. What role do diet and lifestyle play in increasing risks for developing Type 2 diabetes? Give two specific examples of how diet and lifestyle can be used to reduce risks for this form of diabetes. LECTURE NOTES THAT I HAVE: (IT’S A LOT PICK WHATEVER PART U NEED) Week 2 Reading Guide The picture to the left is of a young Pima woman whose tribe struggles with high rates of obesity and Type 2 diabetes. (From the NIDDK, an institute of the NIH). New research shows 21 million adults in the U.S. are living with type 2 diabetes, which shakes out to nearly 9 percent of the adult population. The number of adults with type 2 diabetes has risen in recent years as obesity rates continue to climb. Another 1.3 million adults are living with type 1 diabetes, which occurs when the pancreas can’t produce enough insulin. And another 800,000 people are living with other forms of the condition, like gestational diabetes, according to the new estimates out from the CDC. (This information is more recent than that contained in your text. –JL) This week we’ll be looking at carbohydrates and lipids. One accessory organ of the digestive system that you have already briefly studied (in the chapter on digestion) is the pancreas. It provides many digestive enzymes which are secreted into the upper portion of the small intestine–the duodenum. The pancreas also has an important endocrine function–it makes the hormones insulin and glucagon, and when insulin is absent or in low concentrations, the body can no longer control blood sugar (glucose) levels, and the person has a form of diabetes. Native American populations, particularly in the American Southwest, have especially high rates of diabetes due to a variety of factors such as sedentary lifestyles, a high fat Western diet (fried foods, sugars, and many sources of empty kilocalories) rather than a more traditional diet (lower in fat, higher in fiber, etc.), and obesity which begins at an early age. The Pimas (and other ethnic groups) also seem to have a greater genetic risk for developing diabetes. All of these factors cause alarmingly high levels of Type 2 diabetes, and all the problems that accompany this major disease (vision problems, nerve damage, greater risks for heart disease, circulatory damage, amputation, kidney failure). We will look at diabetes in more detail a bit later in this reading guide. Ch. 4: Carbohydrates: Sugars, Starches, and Fiber 1. Carbohydrates are one of the major nutrient groups (aka “macronutrients”—along with proteins, lipids and water). Think of carbs as being a bit like Legos—you can take smaller Lego pieces and build bigger ones. The smallest pieces of carbohydrates are simple sugars. Look carefully at the illustrations in your text for the three most common simple sugars (glucose, galactose and fructose), and how glucose in particular can be used to build more complex carbs. In general, a healthier diet will include more whole grains (less refined) forms of carbs, and will have fewer sugars. When a grain is refined, it is processed by milling, and loses much of it’s outer coat that contains bran (a source of dietary fiber and vitamins). White flour is processed from a part of the kernel of a whole grain that contains mostly starch and fewer vitamins, and virtually no fiber. When we fortify flour, breads, cereals—we are adding back some of the vitamins and minerals lost in processing the grain. Enriched flour, breads and cereals contain additional amounts of some vitamins and minerals that weren’t originally present, or present at that level in the original grain. Fortification and enrichment of foods (and food other than carbohydrates can be fortified or enriched), is an important public health strategy that helps reduce deficiencies that could leave the population more vulnerable to diseases such as anemia, beriberi or rickets (deficiency diseases), or to birth defects related to low intakes (spina bifida and other neural tube defects). Simple carbohydrates: See the illustration in your text that shows the basic molecular shapes of the simple carbs. Monosaccharides are the simplest sugars—single molecules made up of just 5-6 carbon atoms. Glucose (what our body uses as “blood sugar”), fructose (fruit sugar, and the major sugar found in honey), and galactose (joins with glucose to make lactose) are the most common monosaccharides. (Pentoses–5-carbon sugars–are found in the “backbone” of DNA and RNA molecules). Glucose is the most common monosaccharide, because it is used as a building block for more complex carbohydrates. When we digest starches (whether from a cookie, a potato, or a starchy fruit like a banana) the small molecule that makes up that long, long molecular chain of the starch molecules is glucose. This is the same glucose that provides the primary fuel (energy source) for your brain and nerve cells, and for red blood cells. In one sense, your body doesn’t care where the glucose comes from, but because glucose is always accompanied by other nutrients, it does make a difference to your overall health. (I didn’t want you to get the impression that you could forego whole wheat bread and just head for the Snickers or Oreos). Disaccharides are two simple sugars combined into one molecule (this is illustrated on page 120). Sucrose, common table sugar, is made up of one glucose molecule bonded to one fructose molecule. Lactose (milk sugar) is made of one glucose + one galactose. Maltose (malt sugar) is made of two glucose molecules bonded into one larger molecule. Complex Carbohydrates: Oligosaccharides and Polysaccharides are also called complex carbohydrates. Common forms of polysaccharides are starches (like amylose or amylopectin), glycogen (a type of “animal starch” that allows us to store glucose in the liver and skeletal muscles), and most dietary fiber (both soluble and insoluble—neither of which we can digest—so fiber, unlike other carbs, won’t contribute kcal to our diet, but we still benefit from starch in other ways). Oligosaccharides are made up of 3-10 simple sugar molecules bonded together, and are found naturally in foods like legumes (beans, lentils, onions, bananas, etc.), and can also be produced in the gut during digestion of polysaccharides. Oligosaccharides are important to our intestinal flora (beneficial bacteria). In human breast milk, oligosaccharides perform the work of an infant’s dietary fiber (a breast fed baby’s feces are softer and easier for the baby to poop out because of the oligosaccharides present in breast milk!). Plants produce glucose through photosynthesis. They store the glucose as amylose and amylopectin—both of which we refer to as “starch.” (About 70% of the starch in our carbohydrate-rich foods—-breads, etc.—-are in the form of amylopectin, a more branched form of starch). 2. Indigestible carbohydrates are ones that our own digestive tracts have no enzymes to break down. Forms of indigestible carbs are fiber, some oligosaccharides, and resistant starch. Sometimes stand up comics will joke about dietary fiber and old people—as if only the elderly need to be concerned with fiber. Fiber (and other indigestible carbs) are actually an essential component of a healthy diet no matter your age. Dietary fiber has two basic forms–soluble and insoluble, and each type has its own different health benefits—discussed in your text. Your text also discusses the relationship between fiber and risks for colon cancer (fiber can reduce risks for certain types of colon cancer). Phytates are compounds that often occur with fiber—this is a plant compound that has a negative effect on our ability to absorb certain nutrients, such as calcium, iron or zinc. Dietary fiber can be soluble (dissolves in water, forming a thick solution, and can be digested/fermented by bacteria found in the large intestine); or it can be insoluble. Insoluble fiber has indigestible beta bonds between the glucose molecules, and not even the bacteria can ferment it. Resistant starches are found in foods like legumes, unripe bananas, and new potatoes—these starches can escape digestion in the small intestine, but can be digested by the bacteria in our colons, keeping our beneficial microflora healthy. Each type of fiber plays an important role in human health. Soluble fiber has been linked to lowering serum cholesterol levels (but you need to eat a lot of oatmeal, apples and beans to get this benefit!). Insoluble fiber has been linked to reducing constipation, and promoting the health of the colon. Conditions such as diverticulitis (infected pouches in the large intestine, which makes eating and bowel movements a painful experience), can be largely prevented by having good levels of fiber in one’s diet. Fiber promotes GI tract motility (movement of foods through the tract). Soluble fiber, resistant starches, and oligosaccharides promote a healthy intestinal flora—the bacteria in your large intestine can ferment (digest) some of the fiber that you aren’t able to digest—this keeps the bacteria healthy, and in the process produces compounds of benefit to us: vitamin K, biotin, short chain fatty acids that may help with cancer reduction and cholesterol levels. Oligosaccharides do increase flatulence (gas!). The gas that you express is a by-product of the action of your beneficial bacteria on the fiber. If this is a big problem for you, there are anti-gas products on the market. Both types of fiber have a role to play in weight control, and in reduction of risks for colon cancer. The EPIC study (a huge epidemiological study done in Europe, where over a half a million people were studied over a 6 year period) showed that those who ate more fiber had a significantly lower risk for developing certain forms of colon cancer. Americans eat less fiber, fewer whole grains, less fruits and vegetables than Europeans, and similar studies in America (not as large, nor as long) have yielded less significant results about the role of fiber. The results from the larger study do support the role of fiber in reducing colon cancer risks. At age 50, you will probably have a diagnostic test called a colonoscopy to check for the early signs of colon cancer—colon cancer is an agonizing way to die, but is a totally treatable illness if caught early. You will make your colonoscopy a happier event if you make sure your diet includes good levels of fiber, and also plenty of healthy exercise (physical exercise helps move things through the digestive tract). Most Americans eat only about 50% of the amount of fiber they should eat. Try for a minimum of 25 grams, and preferably more (men should get about 38 grams/day). If you are eating a diet rich in whole grains, veggie, fruits (and beans) you are probably doing well in the effort to get fiber. There are sources of functional fibers—fiber found in special foods or found in fiber supplements. These have been extracted from plants, and/or made in a lab. They benefit us as do naturally occurring fibers, but natural sources of fiber (in whole foods) are preferred—they come bundled with other nutrients including vitamins and minerals also found in the food. Some of these manufactured fibers aren’t found in nature. Fiber helps with blood glucose control, and with a sense of fullness and meal satisfaction. This can translate into better weight management, as well. 3. In your text there is an illustration of the human digestive system showing how carbohydrates are digested in the body. Carbohydrate digestion begins in the mouth (very minor digestion of starch by salivary amylase), and continues in the small intestine. If you look at this illustration closely, you’ll see that most carbohydrates can be digested into a few simple molecules (the monosaccharides—this occurs at several locations along the small intestine). Most of these monosaccharides are glucose, or can be converted to glucose later (usually in the liver). This makes sense: starches are made up of chains of glucose molecules, and all of the disaccharides have at least one molecule of glucose as part of their two-molecule structures. So, the most common molecule from the digestion of carbs is glucose! This certainly is to our advantage, as glucose is a primary source of energy for body cells, especially for the cells of the brain, and for red blood cells. NO DIGESTION OF CARBS FROM OUR OWN ENZYMES HAPPENS IN THE LARGE INTESTINE. There is some digestion of soluble fiber, and resistant starches in the large intestine, but it is done by bacteria that live in our colon. 4. Lactose, aka “milk sugar”, is a disaccharide, made up of a glucose and a galactose molecule bonded together. To break that bond, the enzyme lactase is needed. For most of us, lactase is needed while we are breast feeding or being nursed, but lactase production begins to decline in most individuals in the world. In many cultures, milk and dairy products aren’t as big a part of the diet as in Western cultures (people of European, or northern European heritage). Lactose intolerance is most common in the U.S. in people of Asian, Native American or African or Mediterranean ancestry. (Take a look at the map showing occurrence of latose intolerance in your text–in general you will see the farther north you are, the less intolerance there is in the native populations.) Occasionally, an infant is born with a lactase deficiency, which makes it difficult to digest the form of carbohydrate found in breast milk (or any milk). Usually. however, most babies never have a problem digesting lactose. It would be counter-productive for a baby to be lactose intolerant, but many adults eventually are lactose intolerant. If lactose intolerance is going to show up in a child, the child will usually begin to show symptoms around age 6—some intestinal discomfort, gas, etc. Fermented dairy products (yogurt and cheese) have had the lactose already digested by the bacterial cultures used to make that food, and small amounts of these foods can be eaten even by people with some degree of lactose intolerance. This is helpful, because it means it is still fairly easy for a person with intolerance to get good sources of calcium daily. An intolerance is NOT an allergy. The immune system isn’t involved. If you are intolerant, you simply aren’t making enough of the digestive enzyme. Since dairy foods are the primary source of calcium and vitamin D in the U.S., what do you do if you are lactose intolerant? The recommended three servings of dairy can be divided up into smaller servings taken in through the day. However, if you are totally lactose intolerant, and can’t cope even with small amounts of dairy, you can eat foods containing calcium, such as fortified soymilks, tofus, some vegetables, and fermented dairy (cheeses, yogurts). Fish can also provide calcium, and some fish, such as salmon, are also good sources of vitamin D. Lactose free milk is also available in the supermarket. Supplements of calcium and D are also perfectly acceptable options. 5. The main function of carbohydrates in the body is to provide energy—to be broken down into smaller molecules that the cells of the body can use for their metabolic processes. Glucose, as we’ve already said, is the most common small molecule to result from carbohydrate digestion. Glucose is the body’s primary metabolic fuel. Although your tissues can use fats and amino acids (from the digestion of proteins) as a fuel source, your brain and your red blood cells can only use glucose (and under starvation conditions, a by-product of incomplete fat digestion called ketones—yes, Dr. Atkins, you need adequate carbs in the diet [about 100-130 g/daily] to properly convert fats to energy). Because glucose is so important to our overall health and normal functioning, the body has mechanisms to make sure the level of glucose in the blood stays within normal range (70-110 mg/dl). The steps of glucose use and regulation are summarized for you below:. When you eat carbs (or proteins with amino acids that can be converted to carbs–glucogenic amino acids), as digestion occurs, glucose levels rise in the blood stream. As glucose reaches a particular level in the blood, the pancreas is stimulated by this rise to release the hormone insulin into the blood (the pancreas produces enzymes for the digestive tract, but also hormones for glucose regulation). Insulin stimulates the liver to absorb glucose from the bloodstream and in muscles. The excess glucose is chained together in storage molecules called glycogen (this is a type of starch made by animals). Glycogen is stored mostly in the liver, and a smaller amount in muscles. The amount of glucose stored in our bodies is indicated by these average values: 5 grams of blood glucose 75-100 grams of glycogen (stored glucose) in the liver; notice, this isn’t a lot of kcal, so this is emergency fuel only (300-400 kcal of energy) to stave off dips in blood sugar levels 300-600 grams of glycogen stored in skeletal muscle tissues (this glycogen isn’t used to regulated blood glucose, it stays in the muscles to provide energy for sudden bursts of skeletal muscle activity for emergencies, or athletic events of quick duration). Another way to think about the amount of carbohydrate distributed in the body is to think about it in terms of the kilocalories. The energy value for CHO (an abbreviation that means “carbohydrates”) is 4 kcals/gram. An individual has approximately 20 kcals of carbohydrate—in the form of glucose—in the blood, 300-400 kcals stored in the liver (as glycogen), and 1,200-2,400 kcals stored in the muscles (again as glycogen). We can see why we want to eat a high carbohydrate diet. We need to replace all that is lost during exercise, and during a normal day of energy use. The longer we exercise, the more carbohydrate stores are depleted. The depletion of carb stores can lead to mental and physical fatigue, which can reduce our ab8ility to perform both mentally and physcially. As glucose is used by the body’s cells to provide energy, glucose levels in the blood falls. If it falls below a certain level, the pancreas is stimulated to release a second hormone called glucagon. Glucagon stimulates liver cells to breakdown some of it’s stored glycogen (glucose is stored as glycogen inside liver cells), and the glucose molecules from that breakdown are released into the bloodstream. This release of glucose helps raise blood glucose levels enough to stay within normal range (unless a person is fasting or starving, in which case stored glycogen gets used up). This “dance” between insulin and glucagon goes on all the time. Other hormones, especially during a time of crisis, will enhance the role of insulin to make sure all tissues are able to meet the high demands for energy (epinephrine, norepinephrine, cortisol and growth hormone can all have this effect, though not all by the same mechanism). How cells turn glucose into usable energy: The exact process by which your cells turn glucose into energy begins when glucose enters a cell (some of this is a review of material covered in week 1): It is initially broken into two 3-carbon fragments in an anaerobic process called glycolysis. This process has many steps, and ultimately produces a small amount of energy that is stored as ATP (a high energy molecule that the cells use to fuel other cellular processes). Glycolysis doesn’t require oxygen to occur, so it is an anaerobic process common to all organisms on earth. When oxygen is present, aerobic metabolism can proceed. Acetyl CoA can form, and this molecule carries fragments from 3-carbon fragments from glycolysis into the mitochondrion of the cell (pictured for you in your text). The mitochondrion is often referred to as the powerhouse of the cell—as it is the place where most of the cell’s ATP is made. In the mitochondria (cells have thousands to millions of these tiny structures), the carbons are stripped off in a metabolic process called the Citric Acid Cycle (it has other names, too), converted to carbon dioxide (CO2), and energy is harvested. In the electron transport chain in the mitochondria, the energy harvested in the Citric Acid Cycle is used to create a tiny amount of electric current that turns a tiny turbine called ATP synthase, an enzyme that uses this electrical energy to make ATP. The mitochondria of our cells make most of the billions and billions of ATP molecules we use daily. This energy (which is harvested from the nutrients we eat), makes it possible for chemical processes that are involved with healing, thinking, moving, etc. to occur. When glucose is not readily available to the body, other molecules can be used to generate energy. Some amino acids can be converted to glucose by the liver (and to a lesser extent by the kidneys) in a metabolic pathway called gluconeogenesis. When people are starving, they will break down their own stored proteins (in muscles, organs and other tissues) to harvest amino acids that can be used to make glucose (the primary fuel for the brain). This is why such individuals look too thin, or even become wasted in appearance. Fats can’t be converted to glucose, but can be used by cells to generate energy in the Citric Acid Cycle and the electron transport chain. To be fully converted to glucose carbohydrates must be present to help move fats through the Citric Acid Cycle. When carbs are being restricted (dieting, high protein diets, starvation, eating disorders), the incomplete metabolism of fats produces compounds called ketones (or ketone bodies). This can be used as an emergency fuel by the brain, and by other organs. Interesting, in high protein diets, the build up of ketones can cause nausea, bad breath, and can make you feel less like eating—probably the secret to losing weight on Atkins and similar diets! In a person with Type 1 diabetic, the build up of ketones (when glucose builds up in the blood but is unable to enter the cells due to the lack of insulin when they disease hasn’t been diagnosed, or has been diagnosed but is poorly controlled), causes a condition called ketoacidosis which can result in coma and death. 6. Your text discusses the glycemic response (see page 126). The glycemic response refers to how quickly a particular food will be digested, absorbed and cause blood glucose levels to rise. Many foods have been analyzed and listed in a Glycemic Index. The larger the index number for a food, the more quickly it releases glucose after digestion and absorption into the bloodstream. The general theory to the Index is that eating lower on the Index means you are selecting foods with more fiber, more complex carbs, and that these foods will release their glucose more gradually into the blood. Blood glucose levels fluctuate less, blood sugar is more stable, and the Index is a tool one can use to plan a healthier diet. This is all completely true up to a point—there are, however, other factors that you need to take into account: where a food scores on the Index is due to the type of carbs found in that food, and the amount of fat and protein that is also present in that food; and what other foods are present in a meal no one eats just a single food item at a meal; meals are mixtures of different foods, all with different locations on the Index the fat content of a food (ice cream, a sandwich, pasta and sauce, etc.) slows the release of glucose from the meal that food is a part of, even if parts of the food are high on the index—for example, the jelly on a peanut butter and jelly sandwich is high on the index, but the whole wheat bread is lower—and the fat in the peanut butter will also slow the release of glucose from the sandwich so, if we are trying to eat “low” on the index, we need to look all the foods in that meal, and also how they will be prepared (baking vs. frying, for instance) the concept of glycemic load looks at not just the glycemic index value for a food, but how many grams of that food are eaten; this means you are looking at not only the quality of the food (glycemic index), but the quantity of the carbs you’re eating; glycemic load may be more useful in really predicting the effect of a food on blood glucose; again, a lower value is preferable to a higher one, and you still have to take into account the total meal the biggest drawback to using either the glycemic index or a calculation of the glycemic load in diet planning, is that both of these values are looking at single foods—not the full meal of which they are a part Is this effort worth doing? High blood glucose levels can cause excessive insulin secretion which contributes to the decline in function of insulin-producing cells in the pancreas, and greater loss of sensitivity or responsiveness by body cells to the signal of insulin—both contributing to Type 2 diabetes. Paying attention to glycemic index values or the glycemic load is just another tool one can use to build a healthier diet.