Download Carbohydrates. The basis of Mediterranean style eating

CARBOHYDRATES
The basis of Mediterranean style eating
CARBOHYDRATES
The basis of Mediterranean style eating
The Double Food & Environmental Pyramid
The “Double Food/Environmental Pyramid” combines nutritional information from the Food Pyramid with findings about
the impact that individual foods have on the environment. The model was created by the Barilla Center for Food & Nutrition
(BCFN) to show that the foods that we have recommended to eat regularly also have the lowest environmental impact and
vice versa. To learn more visit: www.barillacfn.com
FOOD AND NUTRITION: A HISTORY OF COMMITMENT AND PASSION
For over 130 years, the Italian family business of Barilla has considered eating as a moment to be shared,
to be rich in experience and taste, and to help people
live better.
Barilla is the company that helps maintain and
improve the well-being of people, communities
and the planet on which we live:
• turning high quality ingredients into good wholesome foods, that are safe, nutritionally sound and
meet the daily nutritional requirements of the
whole family
• developing products according to the Mediterranean Food Model and respecting the environment
• promoting a healthy lifestyle through educational
projects, activities, and events for young people
and families
Barilla firmly believes that the dual objective of
taking care of both people and the planet is achievable. The Mediterranean Food Model is not only an
important reference point for promoting good and
healthy eating habits, but also states that the foods
which are good for us are the ones with the lowest
environmental impact. This is shown by the Double
Pyramid, which was developed in 2009 by the Barilla
Center for Food & Nutrition, a non-profit think tank.
Barilla’s ambition is to double its business by 2020
through the promotion of positive and healthy eating habits, while continuing to reduce our environmental impact, in order to be “Good for You, Good
for the Planet”.
CARBOHYDRATES: THE BASIS OF
MEDITERRANEAN STYLE EATING
[Adaptation by Barilla from Oldways Preservation and Exchange Trust]
The Mediterranean Food Pyramid: a modern, tasty and healthy way of eating.
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Vegetables, fruit, legumes,
cereals, and pasta: foods that
add to the beneficial effects
of Mediterranean style eating
are also our main sources of
carbohydrates.
Scientific evidence from the past 50 years has
shown that following a Mediterranean Diet helps
protect us against the risk of developing cardiovascular disease1, can prevent certain tumors2-4,
reduces the likelihood of a stroke5, seems to promote a long life6, improves brain performance7
and helps maintain good health8. In 2011, UNESCO declared the Mediterranean Diet as an
Intangible Cultural Heritage of Humanity.
WHERE ARE CARBOHYDRATES FOUND?
Natural sources of carbohydrates are foods such as:
cereals, pasta, bread
fruit and fruit juices
vegetables
milk and dairy products
Other foods such as sweets and drinks that contain added sugars.
Typical foods in the Mediterranean Diet include
vegetables, legumes, cereals, fresh and dried fruit9
and all sources of carbohydrates. The basis of the
Mediterranean style diet is therefore made up of
carbohydrates, as shown by the two largest segments of the well-known Food Pyramid.
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THE MAIN TYPES
OF CARBOHYDRATES
In food there are different
types of carbohydrates,
simple and complex,
depending on the type and
number of molecules of
which they are composed.
Carbohydrates are the main source of energy in
our food. Our body uses carbohydrates to obtain glucose, the “fuel” that provides the energy
needed for it to function. The body can either
consume it immediately or store it in the liver to
use when necessary.
Depending on the type and number of molecules
of which they are composed carbohydrates can
be categorized as either simple or complex.
SIMPLE CARBOHYDRATES
Simple carbohydrates, commonly known as sugars,
are monosaccharides and disaccharides, made up
of one or two molecules of simple sugars.
MONOSACCHARIDES
Glucose: an ingredient of both table sugar, sucrose, and complex carbohydrates.
Fructose: the sweetest sugar and found in honey
and fruit.
Galactose: the most similar to glucose, is not
very sweet and found in milk and dairy products.
DISACCHARIDES
Disaccharides are made up of two types of monosaccharides:
Sucrose: made up of glucose and fructose,
known as common table sugar.
Lactose: (galactose + glucose) is found in milk
and dairy products.
Maltose: made up of two glucose molecules
and found in flour.
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COMPLEX CARBOHYDRATES OR
POLYSACCHARIDES
Complex carbohydrates are made up of long
chains of interconnected monosaccharides.
The main complex carbohydrates are:
Foods:
Grams per 100g
of product
Corn flakes (low-sodium)
88.8
White rice (uncooked)
79.15
Whole wheat pasta (uncooked)
75.03
Kidney beans (uncooked)
60.0
White bread
50.0
Glycogen: an energy reserve for animals and
humans, present in the liver and in the muscles.
Wholemeal bread
42.71
Rice noodles (cooked)
24.01
Dietary fibers: non-digestible complex carbohydrates. They are divided into soluble fibers,
such as pectin, and insoluble fibers, such as
cellulose and lignin.
Vanilla Ice cream
23.60
Potatoes (boiled)
20.13
Apples (unpeeled)
13.80
Onions (boiled)
10.15
Red cabbage (raw)
7.37
Sweet pepper (raw)
6.03
Mozzarella (whole milk)
2.19
Starch: an energy reserve for plants and has
a granular shape, with size and dimensions
depending on plants from which it derives. Its
digestibility is inversely proportional to the
size of the granules.
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Carbohydrate content of certain
foods 10
The Magic of Starch
Take a handful of spaghetti and throw it into boiling water. The rigid pieces quickly
become softer, bend and increase in volume. We take this behavior of pasta for granted
when it’s added to hot water, but what exactly happens to the structure of the spaghetti
to cause this change? The first answer is that pasta, like rice, potatoes or bread, contains a
large amount of starch.
But what is starch? Starch is a storage compound that accumulates in the seeds of
plants. The starch is made up of long chains of glucose and is granular in structure. The
raw starch granules are so dense that they are difficult to digest. This source of essential
energy can only be accessed once cooked, making it easier to digest.
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HOW WE USE
CARBOHYDRATES
Carbohydrates, consumed
via foods, are the main
source of energy for the
body
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A proper diet must satisfy two needs: provide
energy, in particular through carbohydrates and
fats, and provide all the nutrients (protein, vitamins and minerals) needed for the body to
function.
CARBOHYDRATES, A SOURCE OF
ENERGY
All carbohydrates are used to produce energy. Glucose itself is one of the main sources of
energy used by all body cells, as well as being the
only source for red blood cells and the nervous
system. Its availability is crucial for the correct
functioning of these tissues. A lack of glucose can
have serious consequences for one’s health. It has
been calculated that, under normal circumstances, an adult needs about 180 grams of glucose
per day, from any source, in order to meet the
body’s energy needs. (FAO, 1980)
BUT HOW DO WE OBTAIN GLUCOSE?
Glucose is derived by the digestive system through the absorption of carbohydrates in foods.
For carbohydrates to be absorbed, they must first
be digested, broken down into single units or monosaccharides. Once ingested, carbohydrates undergo the digestion process by various enzymes.
These are proteins capable of reducing more
complex substances (such as starch) into simple
units (such as maltose), so it becomes available
for the body’s needs.
Carbohydrates contained in food
Digestion and absorption
Storage of glycogen
Gluconeogenesis from
enzyme activity
Amino acids
Number of enzymes
Liver
Muscles
Glycerol
Fat
Glucose
Protein degradation
Protein synthesis
Glucose usage
Insulin sensitivity
Glucose usage
Insulin sensitivity
Lipolysis
Metabolism of carbohydrates taken with food and the destination of glucose.11
The process of digesting carbohydrates begins in
the oral cavity and is completed in the duodenum,
which “transforms” carbohydrates into simple
sugars or monosaccharides.
11
FROM FOOD TO GLYCEMIC RESPONSE:
A 6 STEP JOURNEY
The body is able to use or store glucose through
a series of complex metabolic processes in which
insulin plays a key role.
1. Monosaccharides such as glucose are absorbed to a small extent by the stomach and for the most part by the
small intestine, where they pass into the bloodstream through the intestinal villi.
2. Through the bloodstream, glucose is able to reach all areas of the body (brain, red blood cells, skeletal muscle, cardiac muscle, etc.) and be used by the cells of these organs and tissues to produce energy. The amount of
glucose in the blood and its use by the cells is regulated by insulin, a hormone produced by the endocrine part
of the pancreas.
3. Insulin works as a door allowing glucose to enter the cells, as it binds to specific structures present on the
cell wall (insulin receptors). In this way, the glucose is literally “taken out of circulation”, reducing its level in
the blood (glycemia or blood sugar). Without insulin, the glucose continues to circulate, increasing blood sugar
levels and depriving cells of their primary source of energy.
4. Glucose in excess of the energy needed by the body is captured mainly by the liver and the muscles and stored
there, thanks to insulin. The individual glucose molecules are added to the polysaccharide chains glycogen,
already present in the liver and in the muscles, and forms an energy store (the so-called medium-term energy
reserves). The additional carbohydrates in excess of caloric needs are instead converted into fat and stored in
the fat tissue (long-term energy reserves).
5. After the intake of food containing carbohydrates, the glucose level detected in the blood (blood sugar) is adjusted. This is called the glycemic response.
6. With continued overeating, the body’s cells gradually lose their sensitivity to insulin (insulin resistance). The
“door” no longer functions and the glucose can no longer enter the cells, but remains in circulation, resulting in
a permanent increase in glucose levels in the blood. This condition is often seen in obese people. It’s been found
that excess weight reduces the sensitivity of the tissues to insulin.
(Source: Nutrition Foundation of Italy12)
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NOT ALL CARBOHYDRATES
ARE THE SAME
When chosing carbohydratecontaining foods, we
have to consider that all
carbohydrates are not the
same.
Increased importance is now placed on the quality
of carbohydrates, as it influences the effect carbohydrates have on the body.
WHAT DEFINES THE QUALITY OF CARBOHYDRATES?
The quality of carbohydrates comes from:
1. Absorption rate, defined by the glycemic index
2. Content of dietary fiber and whole grains.
1. Absorption rate
The glycemic index allows us to distinguish between:
• Slowly absorbed carbohydrates that have a
lower glycemic response, causing glucose levels
to rise slowly and helping induce a feeling of
satiety = low glycemic index (GI).
• Rapidly absorbed carbohydrates that raise glucose and insulin levels in the blood very quickly =
high glycemic index.
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The best foods for glucose metabolism and for
health, such as pasta cooked “al dente”, vegetables
(but not potatoes) and fruit, are absorbed more
slowly and correspond to a low glycemic index
(GI): less than 55.
Foods with a high glycemic index (greater than
70) cause insulin levels in the blood to rise, leading to an increase in fat storage, higher levels of
triglycerides in the blood, increased appetite and,
over time, resistance to insulin.
2. Fiber content in food
A diet high in carbohydrates and fiber (more than
30 grams of fiber per day) gives positive glycemic
control.13
The foods richest in fiber are:
• fruits, legumes and oats (sources of soluble fiber)
• foods made from whole grains, wheat bran and
vegetables.
GLYCEMIC INDEX (GI)
Determines the value of carbohydrates, with a scale ranging from 0 to 100, in order to
distinguish those that are digested, absorbed or metabolized rapidly (high GI) from those
which are slowly digested (low GI).
The GI quantifies specific physiological properties of carbohydrates-containing foods,
including delayed gastric emptying and a reduction in the digestion and absorption rate of
the intestine.
GLYCEMIC LOAD (GL)
Determines the quality of carbohydrate (and therefore its GI) and the amount present in
the average portion of a certain food (a slice of wholemeal bread), a recipe (for example,
pasta with vegetables) or a complete meal. It is calculated by multiplying the grams of
available carbohydrate in an average portion of food by the glycemic index of that food and
dividing it by 1000 kJ. It’s the best predictor of glycemic response to food.
GLYCEMIC RESPONSE
Describes how the levels of glucose detected in the blood are changed after eating carbohydrate-containing foods. Glycemic response varies from person to person and is influenced
both by individual foods as well as lifestyle (physical activity, metabolism etc...)
(Source: Nutrition Foundation of Italy14)
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The glycemic index (GI) of certain
foods 14
Food:
GI (g)
Sugar
100
Potatoes
87
Cornflakes
White bread
72
Pizza
62
Ripe bananas
62
Oranges
45
Pasta
36-51
Beans
30-43
Lentils
22-30
Tomatoes
16
72-78
9
As with food composition tables, it has been suggested that a low glycemic index be indicated on
food packaging.12
Glycemic response 15
High GI
Blood glucose level
Major international organizations, including the
World Health Organization, recommend
that both the glycemic index and the glycemic
load be included in national dietary guidelines.
Low GI
1
Time/hours
Levels of glucose in the blood after eating foods that have a high or low
glycemic index.15
2
What the experts say
An international committee of experts, the “Carbohydrate Quality Consortium” (CQC), met
in Stresa on June 6-7, 2013 to discuss the importance of the quality and quantity of carbohydrates on an individual’s health.
Here are the key findings:12
Carbohydrates found in foods have, among other things, an important effect on blood sugar
after a meal, the reduction of which is recognized as being beneficial.
One way to reduce high blood sugar after a meal is to eat slowly absorbed carbohydrates
(with a low GI) and by reducing the glycemic load (GL).
The quality of carbohydrates, defined by the glycemic index and the glycemic load, is
particularly important for people who are sedentary, overweight and at risk for developing
type 2 diabetes.
There is convincing scientific evidence that low-GI diets:
• Improve glycemic control in patients with type 2 diabetes.
• Reduce the risk of type 2 diabetes.
• Reduce the risk of coronary heart disease.
PASTA? BETTER “AL DENTE”
Cooking foods that are rich in starch for a longer
time in water speeds up the digestion of carbohydrates and heightens the glycemic peak after
meals. In practice, foods cooked longer have a
higher glycemic index. So, for pasta and rice, it’s
much better to cook them “al dente”, as do the
Italians.
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THE ROLE CARBOHYDRATES
PLAY IN STAYING HEALTHY
All the experts agree:
carbohydrates are good
for us and necessary for
life. It is important to give
preference to those that are
complex, as found in whole
grains, legumes, vegetables
and fruit.
Maintaining an adequate amount of glucose in
the blood (blood sugar) after meals is one of the
requirements for staying healthy and preventing
many diseases. For this reason, both the quantity
and quality of carbohydrates taken in through
food are very important.
CARBOHYDRATES ARE NECESSARY
For healthy eating, carbohydrates are necessary.
All the experts agree: a reasonable percentage of
our energy needs should be derived from carbohydrates. In practice, more than half (55%) of our
total calorie intake should come from carbohydrates. In a diet that provides 2,000 calories per
day, it is therefore recommended to have between
225g and 325g of carbohydrates, with less than
50g of this coming from added sugars. Additionally, our daily diet should include between 25g and
38g of foods that are rich in fiber.16
HOW TO KEEP YOUR ENERGY IN
BALANCE
Energy or caloric balance is one of the key factors
for maintaining good health, eating food in the
right quantity and quality. Just like a balance sheet,
with energy there is the difference between input
and output, between the amount of energy taken
in and that used up for normal bodily functions and
day-to-day activities. When energy expenditure
(measured in kilocalories) is equal to energy taken
in, the energy is in balance. That’s why carbohydrates play such an important role. They are the
body’s fuel, because, once consumed, carbohydrates are transformed into the glucose that gives
us energy.17
Consumption
Absorption
Physical activity
Fats
Thermogenesis
Carbohydrates
Resting
metabolism
Proteins
19
Be careful with ‘low-carb’ diets
Reducing, or worse, completely removing foods containing complex carbohydrates is not good
for a healthy heart or for our metabolism. Moreover, any weight loss achieved by reducing
essential food components, such as complex carbohydrates, undermines us in the long run and
instead increases cardiovascular risk factors.
It’s better to “tailor” our food model based on personal preferences and our metabolism,
as recommended by the Mediterranean Diet.18
Some high-protein low-carb diets19
20
Scarsdale
A low-calorie diet (850 kcal to 1200 kcal per day), low in carbohydrates and fats.
Distribution of macronutrients: protein 43%, carbohydrate 34.5%, fat 22.5%.
By excluding certain foods, you are likely to run into nutritional deficiencies.
Atkins
Based on the principle of ketogenesis, producing energy from protein and fat, with a
strong limitation of carbohydrates. It’s a way of eating that is difficult to maintain as a
healthy and balanced diet.
Dukan
A ketogenic and low-calorie diet, where the first phase is limited to protein foods only. It’s
likely to induce improper eating habits that can lead to health risks.
Paleo Diet
Based on the nutrition that primitive cavemen would have followed before the discovery
of agriculture, it’s centered on the regular consumption of lean meats, fish, dried fruit,
fresh fruit and vegetables. In the long term, can lead to health risks because the intake of
carbohydrates and proteins are unbalanced.
South Beach
Involves eating eggs, fish and lean meats, low fat dairy products, some legumes, vegetables (but not all), a little dried fruit and sweeteners. Fruit is not allowed.
Promotes bad food habits that are not nutrionally healthy.
WHAT SHOULD WE DO:
THE 12 RULES OF MEDITERRANEAN
STYLE EATING
1
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4
5
6
7
8
9
10
11
12
A healthy lifestyle includes a healthy diet, based
on the Mediterranean Food Model, with the right
amount of carbohydrates and fiber, but also regular physical activity:
Vary the ingredients: choose the quantity and quality of food to be consumed during
the week, following the Food Pyramid.
Consume between 225g and 325g of carbohydrates per day, focusing on whole grains,
vegetables and fruits. For example: 1 serving of cooked mixed vegetables (peppers, onions,
peas = 50g) + 1 portion of pasta (about 45g) + 2 slices of wholemeal bread (48g) + 1 portion
of fruit (apples = 16g), which equals 180g.10,20
Do not exceed the 50g of carbohydrates coming from added sugars, such as sucrose.
For example, 1 portion of snacks + 1 portion of sweetened cereal + 1 portion of biscuits + 1
ice cream does not exceed 42g of sugars.21
Include 25g to 38g of dietary fiber in your daily diet. For example, 3 slices of wholemeal
bread a day contain a little under 20g of fiber, 1 portion of boiled artichokes contains about
8g.
Eat less but more often, according to the 1+2+2 formula: five meals a day including
breakfast, two snacks and two main meals.
Spread different types of foods between the two main meals.
Use extra virgin olive oil.
Limit meat consumption (no more than 3-5 times per week) and give priority to eating
fish (at least 2-3 times a week).
Limit added salt to food during cooking or seasoning.
Limit the intake of alcoholic beverages.
Choose water over sugary drinks.
Do at least 30 minutes of physical activity each day (walking briskly, cycling, etc.).10,13,22
21
It is important to focus on complex carbohydrates
(whole grains, vegetables and fruits) and limit intake
of simple sugars (in soft drinks and sugary foods)
THE BENEFITS OF PHYSICAL ACTIVITY
Nutrition and exercise are two fundamental aspects
for the prevention of diseases, such as obesity, diabetes and cardiovascular disease. A common characteristic of healthy nutrition and physical exercise
is establishingg a routine, which is essential for maintaining a correct
rrect long-term lifestyle. Those who are
in the habit of walking or cycling at least 4-5 times
per week (and not smoking) have almost half the
risk of a heart attack.22
Movement is one of the most important things for
good health, as it helps keep the energy balance
under control. Physical
y
activityy is needed to burn
calories, release stress, and improve mood
m
and
23
psychological well-being.
1-2
times
per week
a more intense
and demanding
activity
FOR A SPORTIVE
LIFESTYLE
Aerobics, tennis, football, running
2-4 times per week
FOR A MORE ACTIVE LIFESTYLE
Gymnastics, swimming, dancing, volleyball,
cycling, jogging, about an hour at a time
TO COMBAT A SEDENTARY LIFESTYLE
At least 6 times a week: 30 minutes walk
TO IMPROVE YOUR LIFESTYLE
Park farther away, use public transportation, use the stairs instead of
the elevator, walk to work, do the housework, walk the dog
22
REFERENCES AND SOURCES
1. Estruch R, Ros E, Salas-Salvadó J et al. N Engl J Med. 2013 Feb 25.
2. Couto E, Boffetta P, Lagiou P et al. Br J Cancer. 2011 Apr 5.
3. Agnoli C, Grioni S, Sieri S, et al. Int J Cancer. 2012 Jul 23.
4. Kyriacou K. BMC Cancer. 2012 Mar 23;12(1):113.
5. Kastorini CM, Milionis HJ, Ioannidi A et al. Am Heart J 2011; Oct;162(4):717-24. Epub 2011 Sep 14.
6. Tognon G, Rothenberg E, Eiben G et al. Age (Dordr). 2011; 33(3):439–450.
7. McMillan L, Owen L, Kras M, Scholey A. Appetite. 2010 Nov 26. [Epub ahead of print].
8. Panunzio MF, Caporizzi R, Antoniciello A et al. Ann Ig. 2011;23(1):13-25.
9. Sofi F, Abbate R, Gensini GF, et al. Eur J Nutr. 2011 May 4. [Epub ahead of print].
10. USDA, National Nutrient Database. http://ndb.nal.usda.gov/ndb/search/list [Ult. acc. 12.11.2013].
11. Barret KE, Boitano S, Barman SM, Beooks HL. Ganong’s Review of Medical Physiology; pagg. 349 e segg. Piccin 2011.
12. NFI. Glycemic index, glycemic load and glycemic response: an international scientific consensus summit. Stresa, June 2013.
13. BCFN. Healthy growth and nutrition in children Parma 2010.
14. NFI. Carbohydrates and glycemic index. http://www.nutrition-foundation.it/monografie/Carboidrati-ed-indice-glicemico.aspx (ult. acc.
10.12.2013) (ult. acc. 18.09.2013)
15. Glycemic index Foundation. http://www.gisymbol.com/about/glycemic-index/. Ult. acc. 12.11.2013.
16. SINU. Carbohydrates and dietary fiber. http://www.sinu.it/larn/carboidr.asp. Ult. acc. 12.06.2013.
17. Mannhart C, Mäder U, Sportwissenschaftliches Institut, Bundesamt für Sport, Magglingen. www.suissebalance.ch_logicio_client_
suissebalance_fi le_Grundlagen_Energiebilanz_it.pdf.
18. Wylie-Rosett J, Aebersold K, Conlon B et al. Curr Diab Rep. 2012 Dec 25. [Epub ahead of print].
19. Altroconsumo, April 2013. http://www.altroconsumo.it/alimentazione/dimagrire/speciali/diete.
20. SINU. Calculating Portions. http://www.sinu.it/larn/annesso2.asp. Ult. acc. 16.06.2013.
21. Altroconsumo. http://www.altroconsumo.it/alimentazione/dimagrire/speciali/zucchero-energia-e-calorie. Ult. acc. 12.06.2013.
22. FIPC, Know your numbers, 2008.
23. BCFN. Double Pyramid 2012. Enabling sustainable food choices. Parma 2012.
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