Cyclical Ketogenic Diets Review

Keto Resource

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Carbohydrates and Their Polymers 141 Monosaccharides

Like amino acids there are a large number of significant carbohydrates found in nature. Carbohydrates are known either as aldoses or as alde-hydic polyols because of the aldehydic carbonyl at carbon atom 1 (C1) and extensive hydroxyl (OH) substitution. Carbohydrates also exist as ketoses having an internal carbonyl or keto group ( O) generally at C2, and again, many alcohol (OH) substituents on the carbon chain. Figure 1.9 illustrates these structures for a 6-carbon aldohexose and a 5-carbon aldoribose. Although there are many different kinds of carbohydrate monomers, three members of the family, glucose, ribose, and 2-deoxyribose dominate in biological importance. Glucose is important because it is the key product of photosynthesis, and thus ultimately the main dietary source of energy for nonphotosynthesizing forms of life. Glucose is most familiarly known as the dominant monomer of the very large molecular weight, polymeric compounds glycogen, starch, and cellulose. Ribose and...


The simple sugars (monosaccharides, glycoses), their oligomers (oligosaccharides), and their polymers (polysaccharides, glycans) are collectively known as carbohydrates. They constitute a major class of cell components (Boons, 1998 Collins, 1987 Rademacher et al., 1988). Monosaccharides, commonly named sugars, are aldoses (polyhydroxyaldehydes) or ketoses (polyhydroxyketones) with a general formula, C(H2O) . Sugars contain several chiral centers at secondary hydroxy carbons resulting in numerous diastereomers. These various diastereomers are given different names for example, ribose (Rib) and xylose (Xyl) are two of the four diastereomeric aldopentoses galactose (Gal), glucose (Glc), and mannose (Man) are three of the eight diastereomeric aldohexoses fructose (Fru) is the most common one of the four diastereomeric ketohexoses. Each of the sugars exists as enantiomeric pairs, d and l forms, according to the configuration at the chiral center farthest from the carbonyl group. The...

Life as a Biochemical Process

More and more of the functions of life (e.g. cell division, immune reaction, neural transmission) are coming to be understood as the interactions of complicated, self-regulating networks of chemical reactions. The substances that carry out and regulate these activities are generally referred to as bio-molecules. Biomolecules include proteins, carbohydrates, lipids all called macromolecules because they are relatively large and a variety of small molecules. The genetic material of the cell specifies how to create proteins, as well as when and how much to create. These proteins, in turn, control the flow of energy and materials through the cell, including the creation and transformation of carbohydrates, lipids and other molecules, ultimately accomplishing all of the functions that the cell carries out. The genetic material

Catalysis Metabolic Pathways

The translation of genes into proteins, crucial as it is, is only a small portion of the biochemical activity in a cell. Proteins do most of the work of managing the flow of energy, synthesizing, degrading and transporting materials, sending and receiving signals, exerting forces on the world, and providing structural support. Systems of interacting proteins form the basis for nearly every process of living things, from moving around and digesting food to thinking and reproducing. Somewhat surprisingly, a large proportion of the chemical processes that underlie all of these activities are shared across a very wide range of organisms. These shared processes are collectively referred to as intermediary metabolism. These include the catabolic processes for breaking down proteins, fats and carbohydrates (such as those found in food) and the anabolic processes for building new materials. Similar collections of reactions that are more specialized to particular organisms are called secondary...

Asymmetric Divisions in Embryogenesis

In vitro tobacco zygotes at elongation stage display apical polar distribution of arabinogalactan proteins (AGP) observed by way of epitope detection using monoclonal antibodies (Qin and Zhao 2006). Disturbing the biological activity of AGPs by application of P-D-glucosyl Yariv reagent (PGlcY, Knox 1997) increased symmetrical division of zygotes. AGPs are a diverse family of hydroxyproline-rich glycoproteins typically carrying 90 carbohydrates that play multiple roles in various processes associated with plant growth and development, including cell expansion, cell proliferation (Willats and Knox 1996 Nothnagel 1997 Shi et al. 2003). These results together with previous reports on AGP localization in embryogenesis (Pennell et al. 1991 McCabe et al. 1997) suggest AGPs may be involved in establishing and stabilizing polarity in the zygote as a first step towards asymmetric cell fate determination upon division.

Problemsspecial considerations

Routine withholding of food and fluids in labour has been challenged by a number of authors, particularly those who are not anaesthetists. They point out that absolute starvation is not popular with mothers, that aspiration associated with emergency general anaesthesia nowadays is uncommon and that there may be risks associated with prolonged starvation. On the other hand, there is little evidence that a period of starvation during labour is harmful, although it may be unpleasant. Starvation is associated with ketosis, but this has not been found to affect the duration or outcome of labour.

Computational Biology

Several databases contain information about three dimensional structures of molecules. The Protein Data Bank (PDB) maintained by Brookhaven National Laboratory, contains protein structure data, primarily from crystallographic data. BioMagRes (BMR) is a database of NMR derived data about proteins, including three dimensional coordinates, that is maintained at the university of Wisconsin, Madison (Ulrich, Markley & Kyogoku, 1989). CARBBANK, contains structural information for complex carbohydrates (Doubet, Bock, Smith, Albersheim & Darvill, 1989). Chemical Abstracts Service (CAS) Online Registry File is a commercial database that contains more than 10 million chemical substances, many with three dimensional coordinates and other useful information. The Cambridge Structural Database contains small molecule structures, and is available to researchers at moderate charge.

Methods In Enzymology

Complex Carbohydrates Volume XXVIII. Complex Carbohydrates (Part B) Edited by Victor Ginsburg Volume L. Complex Carbohydrates (Part C) Edited by Victor Ginsburg Volume 83. Complex Carbohydrates (Part D) Edited by Victor Ginsburg Volume 138. Complex Carbohydrates (Part E) Edited by Victor Ginsburg Volume 179. Complex Carbohydrates (Part F) Edited by Victor Ginsburg Volume 362. Recognition of Carbohydrates in Biological Systems (Part A) Edited by Yuan C. Lee and Reiko T. Lee Volume 363. Recognition of Carbohydrates in Biological Systems (Part B) Edited by Yuan C. Lee and Reiko T. Lee

Properties Of The Gastrointestinal Tract

The surface area available for absorption is highest in the jejunum and the ileum, accounting for more than 99 of the total. In the fasted state, the pH in the stomach is 1.7. The acidified contents of the stomach are neutralized in the duodenum by the infusion of bicarbonate ions through the pancreatic duct. Past the pyloric sphincter separating the stomach and the duodenum, the pH steeply rises to 4.6. Between the proximal jejunum and the distal ileum, the pH gradually rises from 6 to 8. The pH can drop to values as low as 5 in the colon, due to the microbial digestion of certain carbohydrates, producing short-chain fatty acids (SCFAs) in concentration as high as 60-120 mM. 70 The GIT exhibits a considerable pH gradient, and the pH partition hypothesis predicts that the absorption of ionizable drugs may be location-specific.

Gasliquid chromatography

Gas-liquid chromatography may be the method of choice when it is necessary to identify or to quantitate one or more carbohydrates especially when they are present in small amounts. Although this technique is often used because it is possible to resolve carbohydrates with very similar structures, the fact that a and 3 anomers and pyranose and furanose forms of the same carbohydrate all give separate peaks is sometimes a disadvantage. Gas chromatography must be carried out using volatile derivatives of the carbohydrates and although many have been studied (e.g. O-methyl ethers, 0-acetyl ethers, trimethylsilyl-0-methyl oximes and 0-trimethylsilyl ethers) using a variety of stationary phases, the O-trimethylsilyl (TMS) derivatives are probably used most frequently, although circumstances may dictate the use of an alternative. Such TMS derivatives are simple to prepare and have been successfully applied to a wide variety of compounds. It should be noted that, in general, carbohydrates...

Biochemical Compounds Structure And Analysis

All living organisms are composed of the same types of substances, namely water, inorganic ions, and organic compounds. The organic compounds including carbohydrates, lipids, proteins, and nucleic acids are often called biomolecules. Biochemical studies of biomolecules start with isolation and purification, the chromatographic techniques that are the most commonly employed. The most informative method to investigate structures of biomolecules is spectroscopic techniques. The computational adjuncts to these techniques are presented. The Internet search for biomolecu-lar structures and information is described.

Sample preparation and handling

Quantitation of lipids may require an initial extraction step. This should neither degrade the lipids nor extract any non-lipid components, such as carbohydrates, amino acids, etc. Individual requirements will dictate how rigorous any extraction and purification procedure must be but several fundamental precautions must always be taken in order to minimize the possibility of errors.

Preparation of Stock Solutions

As most culture media used in research are used in small volumes, it is not necessary to make large volumes of media. Only small volumes of 10-50 ml are typically required. Therefore, it is easiest to prepare media from concentrated stock solutions. Media components are divided into like components with similar in-solution shelf-lives. For example, a stock A would usually contain salts and carbohydrates that are stable in solution for several months. However, for all media it is necessary to add the calcium chloride as a separate stock solution because this chemical can precipitate with other salts.

Overweight or Moderately Obese

For patients who are overweight or moderately obese (BMI 25 to 32), I recommend a caloric deficit of500 to 750 kilo-calories per day to achieve 1 to 1.5 pounds of weight loss per week. The dietitian can design a low calorie, food-based diet that is either balanced-deficit (reducing total number of calories while keeping proportions from carbohydrate, fat, and protein roughly the same as before), or fat-deficit, with most of the caloric reduction resulting from restriction of fat intake. The latter approach is preferable in light of the typical American diet that is too high in fat, especially saturated fat. Also, a greater volume of food can be eaten on a diet that emphasizes complex and vegetable-source carbohydrates and reduces fat to 30 of calories consumed.

Enzymlc methods of carbohydrate analysis

There are a large number of enzymes that are capable of modifying carbohydrates or carbohydrate derivatives, and that may be used in various analytical methods. The hydrolytic enzymes, which break glycosidic linkages, are useful in the study of disaccharide or polysaccharide structure and in methods for quantitation (Table 9.2). Such enzymes will hydrolyse the glycosidic linkages between the monosaccharide residues and release the individual components for further analysis. The enzyme is chosen bearing in mind the nature of the glycosidic linkage involved, which may not be unique to one particular disaccharide or polysaccharide. Thus a-glucosidase will hydrolyse both the a(l 4) linkage of maltose and the a( 1 2) linkage of sucrose, resulting in the release of glucose in both cases.

Survey Of Biomolecules

The bulk of all cells is water, in which relatively small amounts of inorganic ions and several organic compounds are dissolved. The number of distinct organic chemical species in a cell is large, but most may be classified as carbohydrates, lipids, proteins, nucleic acids, or derivatives thereof. Those few compounds not so classified account for only a small fraction of the mass of the cell and are metabolically derived from substances in one of the four major classes. The four major classes of organic compounds have markedly different structures, properties, and biological functions, but each class contains two types of compounds monomeric species with molecular weights of about 102 to 103 and polymeric biomolecules (biomacromolecules), with molecular weights of about 103 to 1010. The Web site of International Union of

Separation and identification of carbohydrate mixtures

Historically, techniques such as the formation of osazones and the demonstration of fermentation have contributed significantly to the separation and identification of carbohydrates. Observation of the characteristic crystalline structure and melting point of the osazone derivative, prepared by reaction of the monosaccharide with phenylhydrazine, was used in identification. This method is not completely specific, however, because the reaction involves both carbon atoms 1 and 2 with the result that the three hexoses, glucose, fructose and mannose (Figure 9.19), will yield identical osazones owing to their common enediol form.

Peptidebased Methods for Detection and Quantification of Autoantibodies

Methods allow investigators to considerably improve epitope-mapping studies by using, for example, overlapping peptides covering the total sequence of large proteins as well as peptides bearing post-translational modifications. The number and potential diversity of the peptides tested also provide for identification of valuable peptide mimics of non-protein autoantigens, such as carbohydrates or dsDNA. Identifying peptide mimotopes should not only improve detection of autoantibodies recognizing non-protein autoantigens but also allow characterization of conformational epitopes that, generally, cannot be identified by classical tests using a limited number of peptides corresponding to linear sequences in the cognate protein.

Metabolism and capacitation

For subsequent activity the prime energy source available to spermatozoa are carbohydrates from the extracellular substrate. Stallion spermatozoa readily metabolize monosaccharide glucose but have a limited ability to utilize fructose. They also have a limited and variable ability to utilize other sugars or more complex carbohydrates as energy sources (Mann, 1964a). In contrast to stallion spermatozoa, bull and ram spermatozoa are able to utilize fructose and sorbitol as energy sources (Mann, 1964a), and will rapidly use all the monosaccharide energy sources available in seminal plasma within 15-20 min at 37 C. This does not occur so rapidly with stallion spermatozoa (Amann and Graham, 1993).

Bform Dna Recognition By Neomycin Conjugates

To date, few carbohydrate interactions with DNA have involved interactions within the major groove. Among the classes of compounds known to exhibit DNA binding are enediyne antibiotics, anthracyclines, pluramycins, indolocar-bazoles, and aureolic acids.8 Of the limited number of carbohydrates known for DNA binding, only a select few have displayed major groove contacts. These

Chemical methods of carbohydrate

Many of the earliest methods available for the measurement of carbohydrates were based on their chemical reactivity and involved the addition of a particular reagent with the subsequent formation of a coloured product. Although the cheapness and technical simplicity of these procedures contributed to their previous popularity, they are inherently non-specific and often involve the use of substances that are now recognized as hazardous. It is essential that the hazard assessment is undertaken before using such techniques.

High performance liquid chromatography

Separation and quantitation of carbohydrate mixtures may be achieved using HPLC, a method that does not necessitate the formation of a volatile derivative as in GLC. Both partition and ion-exchange techniques have been used with either ultraviolet or refractive index detectors. Partition chromatography is usually performed in the reverse phase mode using a chemically bonded stationary phase and acetonitrile (80 20) in 0.1 mol 1 1 acetic acid as the mobile phase. Anion- and cation-exchange resins have both been used. Carbohydrates

Paper and thinlayer chromatography

Prior to chromatography, it may be necessary to remove interfering substances such as protein, carbohydrates and salts and this may be done using an ion-exchange resin. A small column containing a cation-exchange resin, e.g. Zeo-Karb 225, is prepared in the acid form by treating it with hydrochloric acid (2 mol l-1). After the resin column has been washed with water, the acidified sample is applied and the interfering substances washed through with water and discarded. The amino acids are retained on the resin and may be subsequently eluted by adding a small volume of ammonia solution (2 mol 1 to the column and washing through with distilled water. The alkaline eluent is collected and reduced in volume using a rotary evaporator. Other techniques such as solvent extraction, dialysis or protein precipitation may also be used to separate the amino acids from the other components of the sample.

Benefits of Enteral Nutrition

Several specialized enteral formulas are now available to meet the needs of a variety of patients. Different formulas contain varying degrees of protein, carbohydrate, and fat, depending on the patient's underlying disease process and requirements. Standard formulas contain 50 to 55 carbohydrates, 15 to 20 protein, and 30 fat, the caloric density is 1 kcal mL, and the osmolality is close to isotonic (between 280 and 350 mOsm L). Carbohydrates are in the form of oligosacchrides and polysaccharides. Most of enteral formulas do not contain lactose, avoiding the most common disaccharidase deficiency. Proteins are derived from whey, meat, soy isolates, and various caseinates. Fats are usually supplied by vegetable oils and medium chain triglycerides. Numerous other lipids such as fish oils, borage oil, and structured lipids may be substituted. Fiber is added to some formulas for avoidance of diarrhea. Elemental diets and semi-elemental small pep-tide formulas maybe useful in selected...

Oxidative and Nitrative Stress

ADP stimulate excessive mitochondrial oxygen radical production. Oxygen radical production may be especially harmful to the injured brain because levels of endogenous antioxidant enzymes including superoxide dismutase (SOD), catalase, glutathione , and antioxidant vitamins (e.g.,alpha-tocopherol,and ascorbic acid) are normally not high enough to match excess radical formation. After ischemia-reperfusion, enhanced production of ROS overwhelms endogenous scavenging mechanisms and directly damages lipids, proteins, nucleic acids, and carbohydrates. Importantly, oxygen radicals and oxidative stress facilitate mitochondrial transition pore (MTP) formation,which dissipates the proton motive force required for oxidative phosphorylation and ATP generation 18 . As a result, mitochondria release apoptosis-related proteins and other constituents within the inner and outer mitochondrial membranes 19 . Upon reperfusion and renewed tissue oxygenation, dysfunctional mitochondria may generate...

Evaluation of Symptoms That May Be Related to Food Ingestion

The physician needs to establish the timing of the symptoms in relation to a meal and should try to establish a link between specific foods and the presenting symptoms. This can be done best by a diet and symptom diary in which the temporal relation between ingestion of certain foods and the onset of symptoms can be determined. However, bacterial fermentation of unabsorbed carbohydrates may occur many hours after ingestion. Reproducibility of symptom induction by specific foods should be the basis for trial of an elimination diet. Registered dietitians can be a valuable help in sorting through the patient's history and recommending alternative diets.*

Johanna C EscherMD PhD and Hans A BullerMD PhD

Suggestive symptoms have normal breath hydrogen tests. Besides a false-negative test (in subjects who are nonhy-drogen producers, or after recent use of antibiotics), symptoms may be caused by psychological factors, coexistent irritable bowel syndrome, intolerance to other components in milk, or by maldigestion of other carbohydrates (Johnson et al, 1993).

Selection of Phase Compositions

Addition of salts or organic compounds By addition of salts, such as 2 M NaCl, KCl, or (NH4)2SO4, large changes of partition coefficients are possible, caused, for example, by charge differences between the opposite phases (4). Alternatively, chaotropic salts reducing hydrophobic interactions, or such with a salting-out effect and thus increasing hydrophobic interactions can be tested. Further additives of choice are organic solvents, glycerol, ligands, carbohydrates, or protective agents.

Pattern Recognizing Receptors Of Innate Immunity

MBP is produced by the liver and released as an acute phase reactant. It belongs to a family of related proteins termed collectins other members include lung surfactant proteins, SP-A and SP-D, bovine conglutinin, and bovine collectin-43. The collectins exhibit a broad range of target binding. For example, they associate with Gram-negative bacteria, yeasts, Pneumocystis carinii, influenza, and HIV viruses. SP-A and SP-D interact with airborne particulate material including pollen grains. The common feature of the target substances is their accessible carbohydrates (oligosaccharides). Structural information about MBP is informative with regard to pattern recognition. The seemingly broad range of target specificity does not include the carbohydrates associated with self-glycoproteins. The explanation for this important restriction lies in the particular spatial orientation of the hydroxyl groups situated at positions 3 and 4 of the hexose moiety (e.g., N-acetylglu-cosamine, glucose,...

Availability of endogenous lipase and bile salts

Experiments dealing with the effects of viscous carbohydrates on lipase activity in the intestinal contents and pancreas in relation to fat absorption are often inconclusive and the underlying mechanisms are not fully understood. Isaksson et al. (1983a) found an increased lipase output in rats fed a pectin-containing diet, whereas lipase concentration per gram wet material was not changed. Total fat excretion in the faeces was increased at the same time. These results show that pectin obviously stimulated pancreatic lipase output but do not suggest that specific lipase activity was responsible for the increased fat excretion. In contrast, feeding of neither low methylated or high methylated pectin nor of wheat bran changed specific lipase activity (units per mg) or total lipase output in rats (Isaksson et al., 1983b), whereas protein concentration and protein content of the pancreas were altered. These results were interpreted as adaptive changes in pancreatic enzyme production. In...

Medical Treatment Strategies Treatment of Excessive Fluid Losses

D-lactic acidosis is a rare complication of bacterial overgrowth, but may result in serious sequalae including ataxia, dysarthria, opthalmoplegia, nystagmus, stupor, and coma. It may develop when simple carbohydrates, such as glucose and lactose, are malabsorbed, leaving the anerobic flora to ferment them. Diagnosis requires the availability of a serum d-lactic acid measurement the standard lactic acid laboratory test will not detect d-lactic acid.

Application Box 21 Self Assembly in Biology and Technology

The cytoplasm or cytosol is contained by the cell membrane. Cytoplasm is an archaic term based on primitive understanding of the cellular plasm or fluid. Current understanding shows the cytoplasm to be mostly water containing a variety of solutes. Many ions such as calcium, sodium, and potassium ions are found in the cytoplasm and engage in initiating and terminating cellular functions. In fact, the cytoplasm is a semifluid because of the volume and characteristics of its components. In some portions of the cell, the cytoplasm is gelatinous, in other portions, watery. Additionally, numerous compounds including proteins, carbohydrates, and lipids are distributed in the cytoplasm. Unlike the soup analogies used earlier, the ingredients of the cytoplasm are often distributed and arranged in specific portions of the cell, and while they may move within the cell, this movement is frequently directed by cellular machinations and chemical gradients. In an elegant video animation called The...

Susceptibility To Blackfoot Disease

An earlier study on the diet of residents in the BFD-endemic area found that the diet commonly consumed was dominated by sweet potato, intakes of fresh vegetables and fruits were markedly low, and fish was the only notable source of animal protein (Yang and Blackwell, 1961). The diet was adequate with respect to calories, high in carbohydrates, low in protein and extremely low in fat, which might include a deficient intake of essential unsaturated fatty acids. The intake of indispensable amino acids appeared to be above the minimum requirements with the exception of methionine and tryptophan. Although no attempt was made to evaluate vitamin and mineral intakes in the study, it appeared likely that vitamin intake was marginal. The dietary deficiencies were considered to be one of several factors required to induce BFD in susceptible individuals. An early case-control study showed that BFD patients had a lower socioeconomic status than matched controls showing odds ratios of 3.3 and...

Posttranslational modifications of PSGL1 required for binding to selectins

X-ray crystallography was used to solve the structure of the lectin and EGF domains of P-selectin bound to a recombinant N-terminal fragment of PSGL-1 3 . The PSGL-1 fragment is sulfated on all three tyrosines, and the sequence of the core 2 O-glycan is nearly identical to the one in the synthetic glycosulfopeptide that confers optimal binding to P-selectin (Fig. 1B). The PSGL-1 fragment binds to a large but shallow surface on the lectin domain, opposite to where the EGF domain is attached. The fucose has multiple binding interactions, some of which participate in coordinating the single Ca2+ ion in the lectin domain. The galactose and sialic acid residues make fewer contacts. Other regions of the lectin domain contact certain amino acids plus the sulfates of the middle and C-terminal tyrosines of PSGL-1. Monomeric P-selectin binds with equivalent affinity to native or recombinant PSGL-1 and to the synthetic glycosulfopeptides, with dissociation constants estimated at 80-800 nM 3, 36,...

Molecular Epidemiology

Alice Whittemore and others have also studied prostate cancer in relation to diet among African Americans, Caucasians, and Asians in the United States and Canada. She noted a positive statistically significant association of prostate cancer risk and total fat intake among all ethnic groups combined. This association was attributable to energy from saturated fats after adjusting for saturated fat, risk was associated only weakly with monounsaturated fat and was unrelated to protein, carbohydrates, polyunsatu-rated fat, and total food energy. Fat intake and the percentage of energy from fat also differed appreciably among different ethnicities they were highest in African Americans, followed by Caucasian Americans, Japanese Americans, and Chinese Americans. Similar ethnic differences were seen in the consumption of red meats. However, crude estimates suggest that the differences in saturated fat intake

Nuclear magnetic resonance

The spatial image of other compounds, mainly lipids and carbohydrates that accumulate in storage tissue, can be mapped in vivo using the chemical-shift imaging (CSI) technique (Bottomley et al., 1984). The 1H NMR spectra of water, oil and sugars have different chemical shifts, but the peaks are not resolved unless the water peak is suppressed. The CSI technique applied to 1 day germinating mung bean seeds has shown uniformly distributed oil, which allowed the changes in the image with germination to be attributed to the bulk water fraction (Connelly et al., 1987). Oil and sucrose have been mapped in fresh maize kernels (Koizumi et al., 1995), germinating barley seeds (Ishida et al., 1990) and in developing pea seeds (Tse et al., 1996). choline (DPPC). It was shown that the head groups are in a rigid state above and below the phase transition for both dry DPPC and a mixture of dry DPPC and trehalose. Tsvetkova et al. (1998) used 31P NMR in a comparative study of the interaction of...

Future Avenues Of Investigation

The role of diet composition in PCOS needs further study. In particular, the utility of the gastrointestinal system in assisting energy restriction in PCOS needs to be assessed, as does the effect of high-protein and low-carbohydrate diets on satiety in this group. More data on the type and intensity of physical activity required to improve reproductive performance is needed. Whether this is modified by a concomitant energy-restricted diet will guide the development of well-defined lifestyleintervention programs. These programs need to be tailored to PCOS patients and evaluated against and in addition to metformin. Understanding the motivation of responders and nonresponders to lifestyle intervention, both behavioral and metabolic, will also assist in tailoring clinical management of PCOS.

Differential diagnosis Other glycogen storage diseases

Hypoglycemia in children needs to be treated with frequent feeding. A high protein diet may improve weakness in adult forms of GSD. In GSD VII patients should avoid high-carbohydrate meals that exacerbate the out-of-wind phenomenon, and a ketogenic diet may help. Other potential treatments for GSD V are pyridoxine therapy that improves symptoms in some patients and creatine monohydrate that improves anaerobic but not aerobic exercise capability. Adenoviral-mediated delivery of a myophosphorylase cDNA into myoblasts from patients with McArdle's disease restores myophosphorylase to normal levels, and may prove beneficial as a potential future treatment. Enzyme replacement therapy is also being evaluated in GSD II.

Familial periodic paralyses

Attacks of paralysis are most likely to involve the arms, legs, trunk, and neck, but usually in an asymmetrical manner.They often occur at night, or during rest after exercise. Precipitating factors include stress, trauma, surgery, infections, and high-carbohydrate, high-sodium meals. Proximal muscles are mainly affected. Rarely, death may occur during an attack, from respiratory failure or pulmonary aspiration. Fortunately, however, the diaphragm and cranial muscles are not usually involved. Patients are more sensitive than normal to a reduction in serum potassium, such that muscle weakness may start at a level of 3 mmol l-1, and become profound when it is

Dietary Interventions

Epidemiologic observations of large international differences in the incidence of breast cancer have provided a basis for formulating hypotheses on a possible relation between diet and the development of cancer. The age-adjusted incidence of breast cancer varies from 22 per 100,000 in Japan to 68 per 100,000 in the Netherlands.116 The ratio of breast cancer mortality between the United States and Japan is 3 1 for premenopausal women and 8 1 for postmenopausal women.117 These important differences may possibly be related to fat intake and total calories in the diet. Clinical data collected from case-control studies have demonstrated a positive correlation between diets high in fat and meat and breast cancer.118-122 Experimental studies have shown that omega-6 polyunsaturated fatty acids (PUFAs) contained in high-fat diets promote both mammary tumorigenesis and cell proliferation in chemically induced mammary tumors, whereas omega-3 PUFAs, contained in fish oil, can inhibit these...

Potential Therapeutic Indications

Several lines of evidence implicate elevated 11p-HSD1 activity in the etiology and or maintenance of type 2 diabetes and metabolic syndrome. There is a higher level of 11p-HSD1 mRNA and activity in adipose tissue of obese humans 11,12,14,39 and rodents 40 . Chronic high-fat feeding decreases 11 b-HSD1 activity and mRNA in fat of C57Bl 6J mice, suggesting that this serves as an adaptive mechanism attempting to protect against the adverse metabolic consequence of high-fat feeding 41 . Interestingly, A J mice chronically fed a high-fat diet become obese but are less hyperinsulinemic than C57Bl 6J mice, and this is associated with lower basal adipose tissue 11 p-HSD 1 activity and mRNA and a more pronounced decrease in activity with high-fat feeding 41 . This suggests that lower local synthesis of active glucocorticoid in A J mice confers protection from dysregulated glucose homeo-stasis due to high-fat feeding. Transgenic overexpression of 11p-HSD1 in adipose tissue of mice produces...

Carbon and nitrogencentered glucokinase activators

Compound 5 was assessed in a variety of rodent models of T2D and was effective in lowering basal blood glucose levels in addition to dampening glucose excursions during an oral glucose tolerance test (OGTT). Initial indications of participation of the liver became evident during OGTTs carried out in healthy and T2D mouse models. Compound 5 stimulated peak insulin levels at 45min and an OGTT was carried out 120 min after oral administration of 5. While 5 was equally efficacious regardless of when the OGTT was performed, sulfonylureas were generally more effective when an OGTT was carried out concurrently with the drug-induced peak insulin levels. These results implicated activation of hepatic GK by 5, which was subsequently confirmed in a pancreatic clamp study in rats. These reports indicated improved glucose utilization in the drug-treated group. Therefore, GKAs were shown to increase the threshold of GSIR in the pancreas and also to improve glucose utilization in the liver....

Two Types Of Immunity

Cells Cell Mediated Immunity

The body can control against foreign particles either by cell-mediated immunity or antibody mediated immunity. In antibody mediated immunity, foreign particles called antigens (typically proteins or carbohydrates on the surface of invading cells) stimulate B cells to become plasma cells and memory B cells. The plasma cells produce antibodies and these react with the antigens stimulating their destruction.

Carnitine palmitoyl transferase deficiency CPTD

Muscle cramps and red urine following intense exercise may be ignored (Katzir et al 1996). It is characterised by episodes of rhabdomyolysis, myoglobinuria, and lipid accumulation. Carnitine palmitoyl transferase (CPT) is present on both sides of the mitochondrial membrane, CPT1 on the outer, and CPT2 on the inner (Schaefer et al 1997). It converts acyl-CoA to acylcarnitine, to enable it to cross the membrane, and on the inner side converts it back again. Thus, CPT deficiency impairs the entry of long chain acyl-CoA compounds from the cytosol into mitochondria, with the result that mitochondria are unable to utilise long chain fatty acids for energy production. Muscle requires 50 of its energy from fatty acids and ketone bodies, even at rest. During fasting or exercise, glucose becomes depleted and if fatty acids cannot be used, energy production is reduced, the ATP which is needed to maintain the integrity of the sarcoplasm is depleted, and rhabdomyolysis ensues (Kelly et al 1989).A...

Review of Key Concepts

Dietary Calories (kilocalories) come predominantly from carbohydrates, fats, and proteins. Empty calories are calories gained from foods such as sugar and alcohol that provide little or no other nutrition. 6. Water, carbohydrates, lipids, and proteins are required in relatively large amounts and are thus called macronutrients. Minerals and vitamins are needed in small amounts and are thus called micronutrients. 8. Carbohydrates are used as fuel and as structural components of many biological molecules. 12. Fat contains most of the body's stored energy. Being hydrophobic and less oxidized than carbohydrates, fats contain more than twice as many calories per gram as carbohydrates do.

Vomiting Laxative and Diuretic Abuse

Anorexics and bulimics who vomit to compensate for real or perceived binges may develop perimolysis, a loss of the enamel and dentin on the lingual surface of the teeth caused by recurrent exposure of the teeth to gastric acids. Patients may complain of increased sensitivity to heat, cold, and acidic substances, as discussed in the chapter on oral medicine (see Chapter 7, Oral Considerations in Patients with Gastrointestinal Disorders ). The large amounts of carbohydrates consumed by bulimic patients during binges may further exacerbate the problem, contributing to an elevated frequency of caries. Parotid gland enlargement is a common manifestation of bulimia (Cuellar and Van Thiel, 1986 Jacobs and Schneider, 1985). No treatment is required, and the parotid enlargement usually subsides over time with cessation of vomiting. Some individuals abuse syrup of ipecac to induce vomiting, placing themselves at risk for cardiotoxicity resulting from accumulation of emetine in cardiac muscle....

Diets and Specific Nutrient Requirements

Human studies have shown no benefit from high fat or high carbohydrate (in the absence of a colon) diets, or so-called elemental (small peptide or free amino acid-based enteral formulas), on stool weight, or energy, nitrogen, electrolyte, or mineral absorption. Dietary fat restriction will decrease steatorrhea, but will not increase fat absorption. Medium-chain triacylglycerols (MCT) are absorbed independently of bile salts and may provide a useful energy loss in patients with significant steatorrhea. There is also some colonic absorption. However, they are expensive, often unpalatable (despite modern recipes), cannot be used with cooking oil because of a low smoke temperature, may worsen diarrhea in excessive doses ( 40 g daily), and may have an adverse effect on intestinal adaptation. There have been a few case reports that suggest replacement of bile salts with ox bile may lead to improve in long chain triglyceride absorption (Hofmann, 2000).

Massbased measures for tissue hydration

There are shortcomings in using mass-based parameters for the expression of water content. Plant tissues are heterogeneous, complex biological systems, in which carbohydrates, proteins and lipids and other components have different hydration properties. As a consequence, when plant tissues of various species are equilibrated under given conditions of temperature and relative humidity, equilibrium water content varies considerably among species. For example, seeds with large lipid reserves equilibrate to lower water contents than starchy seeds, even though the chemical potential of water molecules is the same for all tissues when equilibrium is achieved. The disadvantage of using mass-

Glycogen storage diseases

Clinical features are similar to McArdle's although the second wind is less common than in McArdle's. High carbohydrate meals exacerbate exercise intolerance, because the patient cannot metabolize glucose and ends up depleting free fatty acids and ketones - the out of wind phenomenon.

Comparison Of Platyhelminth Adhesives With Temporary Adhesives In Other Marine Macroinvertebrates

A study of the podial prints and podia of Asterias rubens (Echinodermata Asteroidea Forcipulatida) using immunocytochemistry showed that the podial print contained material comprising the two types of putative adhesive secretory granules and the fuzzy coat from the cuticle (Flammang et al, 1998). They found no labelling by antibodies raised to the podial print material on granules produced by the neurosecretory-like cell indicating that this secretion was excluded from the podial print. The podial print material is composed primarily of proteins, but carbohydrates and lipids are also present in significant amounts (Flammang et al, 1998). The protein moiety consists of significant amounts of both charged (especially acidic) and uncharged polar residues as well as half-cystine. The carbohydrate moiety is likely to be acidic containing uronic acids and sulphate groups. The lipid component may come from the membranes of secretory granules (Flammang et al., 1998). bonds (Grenon and Walker,...

Differential diagnosis Other disorders of fatty acid metabolism

In CPT2 deficiency, patients should receive a high-carbohydrate low-fat diet with frequent and regularly scheduled meals, and should avoid precipitating factors as described above. Medium-chain triglyceride supplements and avoidance of long-chain fatty acids may be helpful, but L-carnitine has no effect because carnitine levels are normal in this disease. In CT with primary carnitine deficiency, L-carnitine supplementation (100-200 mg kg per day) will restore plasma and liver carnitine levels. Even though muscle carnitine remains low, muscle strength and other symptoms gradually improve. In VACD patients are treated with a high-carbohydrate, low-fat diet, with or without supplementation with medium-chain triglyceride oil, riboflavin, or L-carnitine. This therapy can stop crises and improving heart and skeletal muscle function. In MTP cod liver oil that is high in docosahexanoic acid may improve the neuropathy.

Inhibition of Glucagon Secretion

Amylin Secrtion

Hypoglycemia-stimulated glucagon secretion and nutrient (amino acid)-stimulated glucagon secretion are two clearly different processes, differently affected by amylin. The balance of glucose fluxes is disturbed in diabetic states, partly as a result of inappropriate glucagon secretion. Although glucose production due to glucagon secreted in response to hypoglycemia is normal or even reduced in diabetic patients, the secretion of glucagon (and production of endogenous glucose) in response to protein meals is typically exaggerated. Absence of appropriate b-cell suppression of a-cell secretion has been invoked as a mechanism that explains exaggerated glucagon responses, especially prevalent in patients with deficient b-cell secretion (type 1 diabetes and insulinopenic type 2 diabetes). A proposed benefit of insulin replacement therapy is the reduction of absolute or relative hyper-glucagonemia. High glucagon is said to be necessary for ketosis in severe forms of diabetes. A further...

Effects on Digestive Secretions

Area Postrema Rat

Complex carbohydrates, proteins, and triglycerides, comprising the three major food groups, are each formed in condensation (water-forming) reactions. Digestion of these foods into absorbable moieties (e.g., monosac-carides, amino acids, and fatty acids) essentially involves the reversal of this process, hydrolysis (Guyton and Hall, 1996b). Gastric acid participates in this action, especially with respect to protein and triglyceride digestion, and may therefore be regarded as a contributor to the aggregate rate of nutrient uptake (Alpers, 1994). inhibitors. Slowing digestion and absorption of complex carbohydrates by blocking a-glucosidase lowers glycemic indices (Balfour and McTavish, 1993 Coniff et al., 1995), and inhibiting pancreatic lipase results in weight loss (James et al., 1997). Pramlintide is reported to lower plasma glucose (Ratner et al., 1998 Rosenstock et al., 1998) and body weight (Whitehouse et al., 1998) in type 1 and type 2 diabetic patients. The extent to which...

Clinical Box 21 Graft Versus Host Disease

Grafty Verse Host Stem Cell

A main reason for the shortage of transplant organs is the fact that the tissues of the donor and the recipient need to match for successful transplantation. Tissues are matched when they have a similar pattern of cell surface proteins. Cell surface proteins are in fact glycoproteins due to the carbohydrates (sugars) attached to their surface. The carbohydrate acts as a flag designating the cell as belonging to the individual. The cellular gly-coprotein pattern may specify an individual within a species or specify a species. If a particular sugar is missing from the surface of a cell, the immune system may recognize this cell as foreign and try to kill it. An attack on self tissue may lead to autoimmune diseases, where the autoimmune reaction can be directed against a specific tissue such as the brain in multiple sclerosis or the digestive tube in Crohn disease. In other cases, the overly active immune system may attack many cells and tissues so that various organs are affected such...

Dynamic Biochemistry Metabolic Simulation

The metabolism serves two fundamentally different purposes the generation of energy and the synthesis of biological molecules. Thus metabolism can be subdivided into catabolism, which produces energy and reducing power, and anabolism, which consumes these products in the biosynthetic processes. Both catabolic and anabolic pathways occur in three stages of complexity stage 1, the interconversion of biopolymers and complex lipids with monomeric intermediates stage 2, the interconversion of monomeric sugars, amino acids, nucleotides and fatty acids with still simpler organic compounds and stage 3, the ultimate degradation to, or synthesis from, raw materials including CO2, H2O and NH3. Catabolism involves the oxidative degradation of complex nutrient molecules such as carbohydrates, lipids, and proteins. The breakdown of these molecules by catabolism leads to the formation of simpler molecules and generates the chemical energy that is captured in the form of ATP. Because catabolism is...

Tissue Adhesion Temporary Adhesion to Living Surfaces

Relatively hard, rigid and non-secretory surfaces such as the carapace of crustaceans probably provide a relatively stable and non-threatening surface for attachment by platyhelminths known to use adhesives such as the temno-cephalans (Sewell and Whittington, 1995). Attachment to cuticular surfaces probably falls between temporary adhesion and tissue adhesion. The biggest likely threat to temnocephalans is moulting when the external cuticle of the crustacean host is shed. Epithelial tissues that line the intestine of vertebrates (e.g. Castro and Harari, 1982 Ishikawa et al., 1994) and which cover the body surfaces, scales, fins and gills of fishes (e.g. Buchmann, 1998a, 1999 Whittington et al., 2000a) are active secretory layers that grow, regenerate and produce mucus containing peptides and carbohydrates that may have immunological activity. The mucus of fish, produced by the goblet or mucous cells in the epithelium, is known to be highly variable chemically between species and there...

Maintenance of the Body

As is usually the case, there are alternative mechanisms of defence if one fails, there is normally a back up mechanism. Foreignness is often a protein, or part of a protein, which is not present in the animal itself. One way to combat it, is to synthesise a protein antibody that can inactivate the foreign protein. Alternatively, a host cell containing a virus or other intruder can be recognised and killed by cells of the immune system. In this way the pathogen is also destroyed. Some carbohydrates, for example particular components of bacterial cell walls, can evoke antibody responses, which can inactivate or kill the invading microorganism. Toxins produced by bacteria can also be recognised as foreign and destroyed.

Metformin Weight Loss and PCOS

Although low-fat, high-carbohydrate diets have been the mainstream approach for weight management, they appear to be no more effective than other dietary patterns that restrict kilojoules (26). Furthermore, high-carbohydrate dietary patterns may worsen the metabolic profile if weight loss is not achieved. Modifying the type of dietary carbohydrate or glycemic index (GI) has been highly controversial (27,28). GI is proposed to both improve the cardiovascular risk profile and aid in weight loss (29,30), although education on GI has not shown an improvement in weight loss at 10 weeks (31) or 1 year (32). Surprisingly, there appear to be no studies on the utility of using GI as a strategy for weight management in women PCOS. Increasing the amount of dietary protein at the expense of carbohydrate has been shown to reduce abdominal fat in insulin-resistant subjects (33,34) and has been shown to be more effective in improving weight loss after 6 months and 1 year (35,36). However, in two...

Adhesive And Other Gland Cells In The Digenea

Cercariae of human schistosomes have been studied most thoroughly because of their economic importance and therefore the anatomy of their gland cells is well known. Penetration of human skin is achieved by the pre-acetab-ular and post-acetabular gland cells, the ducts of which enter the head capsule of the cercaria. However, secretions from the post-acetabular glands that are released before penetration in S. mansoni may have an adhesive role during the period when the cercariae explore the surface of the skin (Robson and Erasmus, 1970). This is consistent with the discovery by Linder (1985, 1986), using lectin-labelling, that secretions from the post-acetabular glands of S. mansoni appeared to function as a glue. Material produced was fibrillar, comprised water-insoluble carbohydrates and was often left as two crescent-shaped spots (Linder, 1985) or 'kissing marks' (Linder, 1986).

Management Of Diabetic Ketoacidosis And Nonketotic Hyperglycemia

Add 100 U of regular insulin to 1 L of normal saline (0.1 U mL), and follow with continuous IV drip of 0.1 U kg actual body weight per h until correction of ketosis. 4. Give SQ dose (10-30 U) of regular insulin when ketosis is corrected and the blood glucose level decreases to 300 mg dL, and continue with SQ insulin injection every 4 h on a sliding scale (ie, 5 U if below 150, 10 U if 150-200, 15 U if 200-250, and 20 U if 250-300 mg dL).

Defects of fatty acid metabolism

There are at least 3 different phenotypes 1. a myopathic form with juvenile- CPT2 adult onset 2. an infantile form with hepatic, muscular, and cardiac involvement 3. a lethal neonatal form with developmental abnormalities. Adults patients develop pain, stiffness, and tightness of the muscles, although they do not get muscular cramps or second-wind phenomena. CPT2 is frequently associated with myoglobinuria. Symptoms develop after prolonged fasting, low-carbohydrate high-fat diets, exercise, infection, cold exposure, and general anesthesia. In most patients strength is normal. In general CPT2 deficiency is more common in males (6 1) with females having milder disease.

Human and nonhuman primate studies

Other environmental factors can influence the effect of alcohol on apolipoprotein levels including level of physical activity 12 and diet. Rumpler et al. 13 examined the effect of adding alcohol to the diet of women consuming either a high fat (38 fat calories) or low fat (18 fat calories). Alcohol (5 of calories) only increased HDL cholesterol while on the high fat diet. This effect was confined to the HDL2 subfraction. Diet The steady state concentration of apolipoprotein A-I is a balance between synthesis and catabolism. Alcohol appears to affect both processes. In a study with healthy men consuming 60-70 g alcohol day for two weeks, alcohol increased apolipoprotein A-I synthesis by nearly 50 14 . Apolipoprotein A-I is synthesized and secreted primarily in the intestine and liver. No studies have examined the effect of alcohol on apolipoprotein A-I secretion in intestinal cells. In vitro, alcohol has been shown to stimulate apolipoprotein A-I secretion from two human hepatoma cell...

Alcoholic Liver Disease Role Of Free Radicals

Other hand, compounds which inhibit cytochrome P4502E1 such as chlomethiazol or diallyl sulfide 90,91 , also inhibit lipid peroxidation, radical production and result in an improvement ofhepatic morphology. Obviously, the degree of induction of cytochrome P4502E1 is of predominant importance with respect to ALD. It is, therefore, concluded that the ROS produced by this pathway may be especially important. This induction is diet dependent and enhanced with unsaturated fatty acids such as corn oil and low carbohydrates. In addition, iron, an important compound in the production ofROS, plays a significant role. Iron supplementation increases liver disease and administration of an iron chelator decreases ALD. Although, the administration of vitamin E to rodents inhibits ALD to some extent, data in humans are not very encouraging. The approach of administering vitamin E together with selenium and zinc to patients with alcoholic cirrhosis did show an improvement in mortality, but the number...

Physical and chemical properties of onions and onionskins

Bulb firmness may be partly related to the adhesion of cell-wall fibrils to one another within the fleshy scales, due to the presence of non-uronide carbohydrates and the strength of the middle lamella (Mann et al., 1986). Changes in carbohydrate metabolism or damage during storage may have bad effects on firmness and onion quality.

Effects of Specific Foods and Food Additives

People ingest a variety of substances that consist of mixtures of chemicals that can have specific effects on the body. These chemicals include primary macronutrients, such as carbohydrates, fats, and proteins micronutrients, such as vitamins and minerals and incidental chemicals that have no nutritive value, but are part of the animals and plants that we eat, such as caffeine in coffee or theobromine in chocolate. These incidental chemicals may be biologically active in the gut and elsewhere in the body and may produce symptoms.

Reactions of the carbonyl group

The reactions of the carbonyl group form the basis of many qualitative methods for the detection of carbohydrates and several have been used quantitatively. These are general methods that often only measure the total amount present in the sample. However, in some cases, reagents or reaction conditions have been modified to improve specificity. Carbohydrates that have a potentially free aldehyde or ketone group exist in solution at equilibrium with the enediol form. At a slightly alkaline pH this conversion is favoured and the resulting enediol is an active reducing agent (Figure 9.19). Reduction methods can be used for disaccharides provided that the aldehyde or ketone group of at least one of the monosaccharides has not been eliminated in the glycosidic bond. Sucrose is an example of a disaccha-ride in which the anomeric carbon atoms of both monosaccharides are involved in the glycosidic bond and the reducing power is lost. However, this distinction between reducing and non-reducing...

To The First Edition

The topics covered in this book fall into three main groups. Analytical techniques such as spectroscopy, chromatography, etc. are particularly important in analytical biochemistry as well as in analytical chemistry generally. The principles of each technique are explained and the scope and applications are discussed. There are chapters on enzymes, antibodies and radioisotopes, substances which it may be necessary to detect and measure but which also can be very useful in a variety of analytical methods. Here again, the basic theory is explained before discussing their applications in analytical biochemistry. Finally, there are four chapters which explain the chemical nature and methods of analysis of the major groups of biologically important compounds, namely, carbohydrates, amino acids, proteins and lipids. While it is appreciated that the range of compounds in this final section could be considerably extended it has been deliberately restricted to those groups which we consider to...


ATP is involved in most cellular processes, so it is sometimes called a currency metabolite. ATP can also be converted to other high energy phosphate compounds such as creatine phosphate, or other nucleotide triphos-phates. in turn, these molecules provide the higher levels of energy necessary to transcribe genes and replicate chromosomes. Energy can also be stored in different chemical forms. Carbohydrates like glycogen provide a moderate density, moderately accessible form of energy storage. Fats have very high energy storage density, but the energy stored in them takes longer to retrieve.

Figure 622

Role of insulin deficiency and the counter-regulatory hormones, and their respective sites of action, in the pathogenesis of hyper-glycemia and ketosis in diabetic ketoacido-sis (DKA).A, Metabolic processes affected by insulin deficiency, on the one hand, and excess of glucagon, cortisol, epinephrine, norepinephrine, and growth hormone, on the other. B, The roles of the adipose tissue, liver, skeletal muscle, and kidney in the pathogenesis of hyperglycemia and ketone-mia. Impairment of glucose oxidation in most tissues and excessive hepatic production of glucose are the main determinants of hyperglycemia. Excessive counterregula-tion and the prevailing hypertonicity, metabolic acidosis, and electrolyte imbalance superimpose a state of insulin resistance. Prerenal azotemia caused by volume depletion can contribute significantly to severe hyperglycemia. Increased hepatic production of ketones and their reduced utilization by peripheral tissues account for the ketonemia typically...

Figure 623

Clinical features of diabetic ketoacidosis (DKA) and nonketotic hyperglycemia (NKH). DKA and NKH are the most important acute metabolic complications of patients with uncontrolled diabetes mellitus. These disorders share the same overall pathogene-sis that includes insulin deficiency and resistance and excessive counterregulation however, the importance of each of these endocrine abnormalities differs significantly in DKA and NKH. As depicted here, pure NKH is characterized by profound hyper-glycemia, the result of mild insulin deficiency and severe coun-terregulation (eg, high glucagon levels). In contrast, pure DKA is characterized by profound ketosis that largely is due to severe insulin deficiency, with counterregulation being generally of lesser importance. These pure forms define a continuum that includes mixed forms incorporating clinical and biochemical features of both DKA and NKH. Dyspnea and Kussmaul's respiration result from the metabolic acidosis of DKA, which is...

Golgi Complex

Golgi Complex

The Golgi35 (GOAL-jee) complex is a small system of cis-ternae that synthesize carbohydrates and put the finishing touches on protein and glycoprotein synthesis. The complex resembles a stack of pita bread. Typically, it consists of about six cisternae, slightly separated from each other each cisterna is a flattened, slightly curved sac with swollen edges (fig. 3.27). The Golgi complex receives the newly synthesized proteins from the rough ER. It sorts them, cuts and splices some of them, adds carbohydrate moieties to some, and finally packages the proteins in membrane-bounded Golgi vesicles. These vesicles bud off

Analysis of CDs

CDs in the reaction fluid are easily separated from each other by high performance liquid chromatography (HPLC), and the contents of these CDs are calculated with a refractive index detector. However it takes a long time to screen y-CD- producing enzymes from microorganisms. A simple colon-metric determination method for y-CD was developed by Kato and Horikoshi (1984). One milliliter of sample solution (up to 700 ig as y-CD) is mixed with 0.1 ml of Bromocresol green (BCG) (5 mM) and 2 ml of 0.2 M citrate buffer (pH 4.2), and the absorbance is measured at 630 nm. Addition of various carbohydrates, such as a-, 3-CDs, glucose and soluble starch, did not cause significant error, as shown in Table 8.7. Table 8.7 Effect of various carbohydrates on the BCG method Table 8.7 Effect of various carbohydrates on the BCG method


Although almost all compounds of biological origin contain some asymmetric carbon atoms, the phenomenon of stereoisomerism is particularly important in the case of carbohydrates. The simplest aldose, glyceraldehyde, has only one asymmetric carbon atom or chiral centre (carbon 2), and therefore only two possible arrangements of the OH and H of the CH2OH unit are possible. If the OH group is shown as projecting to the left on the penultimate carbon atom in the straight chain representation of the molecule, then by convention the molecule is called the L isomer, while if the OH group is represented as projecting to the right it is known as the D isomer. These two stereoisomers of the same carbohydrates are enantiomers or mirror images of one another. All carbohydrates can exist in either of these two forms and the prefix of D or L only refers to the configuration around the highest numbered asymmetric carbon atom. Enantiomers have the same name (e.g. D-glucose and L-glucose) and are...


Because carbohydrates are rapidly oxidized, they are required in greater amounts than any other nutrient. The RDA is 125 to 175 g. The brain alone consumes about 120 g of glucose per day. Most Americans get about 40 to 50 of their calories from carbohydrates, but highly active people should get up to 60 . Dietary carbohydrates come in three principal forms monosaccharides, disaccharides, and polysaccharides (complex carbohydrates). The only nutritionally significant polysaccharide is starch. Although glycogen is a polysac-charide, only trivial amounts of it are present in cooked meats. Cellulose, another polysaccharide, is not considered a nutrient because it is not digested and never enters the human tissues. Its importance as dietary fiber, however, is discussed shortly.


A nutrient is any ingested chemical that is used for growth, repair, or maintenance of the body. Nutrients fall into six major classes water, carbohydrates, lipids, pro teins, minerals, and vitamins (table 26.1). Water, carbohydrates, lipids, and proteins are considered macronutrients because they must be consumed in relatively large quantities. Minerals and vitamins are called micronutrients because only small quantities are required.


A well-nourished adult meets 80 to 90 of his or her resting energy needs from fat. Fat is superior to carbohydrates for energy storage for two reasons (1) carbohydrates are hydrophilic, absorb water, and thus expand and occupy more space in the tissues. Fat, however, is hydrophobic, contains almost no water, and is a more compact energy storage substance. (2) Fat is less oxidized than carbohydrate and contains over twice as much energy (9 kcal g of fat compared with 4 kcal g of carbohydrate). A man's typical fat reserves contain enough energy for 119 hours of running, whereas his carbohydrate stores would suffice for only 1.6 hours.


Although photosynthesis in potato is repressed by high temperature (Ku et al., 1977), it is often not as sensitive to temperature as are tuberization and partitioning of carbohydrates to the tuber reproductive sink (Reynolds et al., 1990 Midmore and Prange, 1992). Therefore, moderately high temperatures can significantly reduce tuber yields even when photosynthesis and total biomass production are relatively unaffected. Potato possesses the C3 photosynthetic pathway, and the tubers are a large 'sink' for carbohydrates. Typically, as much as 70-80 of total dry weight at maturity is in the tubers (Moorby, 1970 Wolfe et al., 1983). Several reviews of the CO2-enrichment literature have concluded that sustained stimulation of photosynthesis by elevated CO2 is most likely in C3 plant species, such as potato, which have a large, indeterminate sink capacity for photosynthates (Stitt, 1991 Wolfe et al., 1998). The experimental data for potato have not always corroborated this hypothesis,...

Parenteral Nutrition

Parentral nutrition delivers a solution consisting of water, electrolytes, amino acids, carbohydrates, fats, proteins, vitamins, and trace elements. These compounds are mixed and delivered over a period of time generally 12 to 24 hours. 555 kcal L (163 g carbohydrates) 400 kcal L (40 g of lipids) 1175 kcal L 70 meq L 35 meq L 5 meq L 5 meq L 15 mmol L To balance


Measuring the amount of ingredients in food is also important. We trust the label on a packet. Some people may be concerned, for example, about the amount of protein, or fat, or carbohydrates in a given product. The reasons may be dietary or even medical. How can we be sure of the constituents Supplies of raw material can vary in quality according to time of year, how the food was grown, temperature and so on, therefore, the proportions will change a little. This needs to be monitored. Traditional approaches such as chromatography are rather time-consuming, and a faster alternative involves combining chemometric and spectroscopic measurements. This can be used either for labelling and regulatory reasons, or to reject batches of materials that are unsuitable. Sometimes less good batches can be used for other purposes, for example, for animal rather than human consumption.

Immune systetn

It is very important to weigh rlie patients daily to assess adequacy of fluid balance. 1'atients with A.RF have ati increase in catabolism which should be reflected in a decrease in tissue mass, The dry weight should fall around 0.2-0. kg day and even more in patients with bypercatabol-ism Tissue diabolism produces endogenous water which is different for carbohydrates, lipids and proteins (sec appendix). The weight reflects fluid intake, output and catabolism. i hcrcforc, a patient with ARF should lose 0 5 kg day if his fluid balance is well managed. However, hypcrcataholism in these patients can be halted with early and continuous high caloric intake.


Available over the counter the decision regarding which one to choose depends primarily on the patient's preference (ie, liquid, capsule, or wafer). It is important to instruct the patient to consume adequate amounts of water with the fiber to avoid potential side effects. If additional therapy is required, osmotic laxatives can be used safely and indefinitely. These include nonabsorbable carbohydrates (lactulose and sorbitol), milk of magnesia, magnesium citrate, or a polyethylene glycol solution (Miralax) (Table 39-3). There is a separate chapter on constipation.

Figure 915

Autosomal-dominant polycystic kidney disease predicted structure of polycystin 1 and polycystin 2 and their interaction. Polycystin 1 is a 4302-amino acid protein, which anchors itself to cell membranes by seven transmembrane domains 10 . The large extracellular portion includes two leucine-rich repeats usually involved in protein-protein interactions and a C-type lectin domain capable of binding carbohydrates. A part of the intracellular tail has the capacity to form a coiled-coil motif, enabling either self-assembling or interaction with other proteins. Polycystin 2 is a 968-amino acid protein with six transmembrane domains, resembling a subunit of voltage-activated calcium channel. Like polycystin 1, the C-termi-nal end of polycystin 2 comprises a coiled-coil domain and is able to interact in vitro with PKD2 11 . This C-terminal part of poly-cystin 2 also includes a calcium-binding domain. On these grounds, it has been hypothesized that polycystin 1 acts like a receptor and signal...

Dietary Assessment

The results of a food diary must be interpreted with caution, as both retrospective underreporting and prospective restrained eating are common. Despite these shortcomings, the information gathered can be very useful. For example, the macronutrient composition of a patient's diet will often be weighted towards fats, simple carbohydrates, and protein. By cutting fat and increasing intake of complex carbohydrates, especially vegetables and fruit, such patients can considerably increase the volume of food they consume as they attempt to reach and maintain a lower weight.


The fact that different amino acids carry different net charges at any particular pH permits mixtures to be separated using low or high voltage electrophoresis. The most frequently used supporting media are paper or thin-layer sheets (cellulose or silica gel) and the locating reagents already described for chromatography may be used for visualization of the spots. Separations at high voltages can be achieved more quickly than at low voltages and one of the principal advantages of the former is that salts and other substances that may be present in the sample affect the quality of electrophoretogram to a lesser extent. This permits the separation of amino acids in relatively crude extracts and untreated fluids, whereas prior to low voltage electrophoresis it is necessary to remove interfering substances such as proteins, carbohydrates and salts using the same methods as described for chromatography.


Sweet, produced by many organic compounds, especially sugars. Sweetness is associated with carbohydrates and foods of high caloric value. Many flowering plants have evolved sweet nectar and fruits that entice animals to eat them and disperse their pollen and seeds. Thus, our fondness for fruit has coevolved with plant reproductive strategies.

Organism Indicators

As in other organisms the energy reserves of fish are carbohydrates, lipids and proteins. Of these, lipid and protein are quantitatively more important. While carbohydrate is an important and essential energy source for certain tissues (e.g. nervous tissue) the ability to store this class of compounds even in its most compact form (glycogen) is limited. These stores are usually the first to be depleted during reduced food availability or other stresses. Fish have mechanisms for synthesizing glycogen from amino acids but not from lipid. Lipid stores can be used to provide the energy for a range of processes including formation of eggs. Protein, primarily white muscle protein, represents a substantial energy reserve which can be called upon in cases of extreme depletion of energy reserves. Natural periods of extreme energy expenditure such as spawning migrations of salmonid fishes indicate that sequential depletion of carbohydrate, lipid and protein reserves occur (Mommsen et al., 1980...

Concluding Comments

Adhesives for attachment to abiotic substrates is poorly characterized (Flammang, 1996), but studies on limpets and starfish indicate that complexes of proteins and carbohydrates are common (Section 9). A.M. Smith et al. (1999) discovered that the limpet, Lottia limatula (Mollusca Gastropoda), is able to change the amount of protein and carbohydrate in its single adhesive secretion and this difference in proportion changes its properties to allow either gliding or adhesion. Similarly for starfish, the ability to vary the ratio of acid mucopolysaccharides to protein across taxa (Flammang, 1996) may alter the strength of the adhesive. In comparison with these marine macroinverte-brates, the chemistry of adhesives in platyhelminths is virtually unknown, largely because of their small size. Indications on present evidence suggest strongly, however, that proteins and, in some cases carbohydrates, are also important in flatworm adhesives. The duo-gland system of turbellarians has...

Water Stress

In the above context, drought tolerance is really desiccation avoidance. Because the mechanisms required to scavenge and sequester water may differ from those that enable the organism to exist without it, tolerance of drought does not necessarily imply tolerance of desiccation. None the less, both desiccation- and drought-tolerant organisms accommodate life at low water potentials ( -1 MPa). Mild drops in water potential (from -1 to about -3 MPa) coincide with a series of metabolic changes that make cells more tolerant of the water stress (Ingram and Bartels, 1996 Bray, 1997 Oliver et al., 1998 see Chapter 11). The products of these metabolic changes (antioxidants, low-molecular-weight carbohydrates, late embryogenesis abundant


Adhesive molecules any pair of complementary cell-surface molecules that bind specifically to one another, thereby causing cells to adhere to one another, as do carbohydrates and protein lectins (q.v.). Phenomena dependent on adhesive molecules include invasion of host cells by bacteria and viruses, species-specific union of sperms and eggs, and aggregation of specific cell types during embryological development. See cell affinity, hemagglutinins, P blood group, selectins.


This chapter clearly demonstrates that African American men have a worse outcome from prostate cancer than do Caucasian men. The multiple factors described in the chapter probably account for this difference. The initial event distinguishing African Americans from Caucasians is high-grade PIN, which may account for an earlier malignant transformation to clinically significant PCa. If hormonal levels and activity are influenced by a high-fat diet as suggested by Ross and Henderson,54 then the pathway of high-fat content-high level of hormonal activity-high-grade PIN may be significantly responsible for the increased clinically significant PCa among African Americans compared to Caucasians at a younger age. High-fat diet or bioactive lipids may also have an independent role in increasing invasiveness and metastases, as is suggested by Gao et al.3 It may be assumed that men who consume a high-fat diet may take in less fiber containing lycopene which may be protective against prostate...

Isaac J Powell MD

The definition of blacks or African Americans as a race in the United States is unclear. There is no genetic definition of any race at this time. Phenotypic heterogeneity is characteristic of the United States population of African Americans. However, there are cultural factors that may define African Americans as an ethnic group or race in relation to health. Recent data demonstrate a strong association between prostate cancer progression and a high-fat diet.1 Whittemore recently reported that among groups of men who consume high amounts of saturated fats, African Americans consumed the most, compared to Caucasians, Chinese Americans, and Japanese Americans.2 Evidence indicating a greater percentage of bioactive lipids in the biologic system of African Americans suggests a diet high in fat content, or greater expression of enzymes converting free fatty acids to bioactive lipids.3 Thus, diet as an epige-netic factor in prostate cancer (PCa) may distinguish African Americans from other...

HONK patients

Blood glucose in these patients can be extremely high without ketosis or acidosis. Management is the same as that for ketoacidosis, except that 0-45 saline is given if the serum sodium value is greater than 150mmol l, and a lower rate of insulin infusion (3units h) is often sufficient. In shocked and dehydrated patients prophylactic, low dose, subcutaneous heparin is considered.


The acidosis of DKA is initially compensated for by hyperventilation. Once the blood pH falls below 7-1, CNS depression can occur and this can prevent compensation. Acidosis will nearly always resolve with correction of fluid balance and cessation of ketosis following insulin therapy. Bicarbonate should be avoided unless the blood pH is less than 7-0, or less than 7-1 and not improving after the first few hours of fluid and insulin therapy. Many formulas exist relating the base excess to the child's weight and the bicarbonate requirement. However, because of the logarithmic relationship between H+ and pH a dose of 2-5 ml kg of 8-4 NaHCO3will correct the pH to 7-2 or 7-3 in all cases. This should be administered slowly over 2 hours by infusion. Recheck the pH after the first hour and stop the infusion if the pH is above 715 as the rest will correct naturally.


Roux Esophagojejunostomy

Dumping syndrome, which is the rapid emptying of undigested food into the intestine and small bowel immediately after a meal, can lead to nausea, emesis, bloating, and diarrhea. Delayed symptoms, including weakness and perspiration, can occur approx 24 h after a meal. The most effective therapy for dumping syndrome is a diet of small, frequent meals that are low in simple carbohydrates, and the avoidance of drinking liquids with meals. Antidiarrhea agents may also be useful.

HT6R antagonists

The 5-HT6 receptor (5HT6R) is expressed almost exclusively in the CNS. Several pharmacological studies and genetic models support a role for this receptor in obesity. 5HT6R KO mice were found to be resistant to body weight gain on a high fat diet 101 . Administration of 5HT6R antisense oligonucleotide complementary to bases 1-18 of the rat 5HT6R cDNA initiation sequence was shown to reduce both food intake and body weight of diet-induced obese rats over a 6-day period 102 . A brain penetrant small molecule antagonist 51 (pK 8.6) was reported to inhibit fasting-induced re-feeding behavior in male Wistar rats at 24 h post dose 103,104 . Mechanistically, these 5HT6R antagonists are believed to decrease g-aminobutyric acid-mediated signaling in the hypothalamus, resulting in release of a-MSH 104 .

Nitrogen Balance

Proteins are our chief dietary source of nitrogen. Nitrogen balance is a state in which the rate of nitrogen ingestion equals the rate of excretion (chiefly as nitrogenous wastes). Growing children exhibit a state of positive nitrogen balance because they ingest more than they excrete, thus retaining protein for tissue growth. Pregnant women and athletes in resistance training also show positive nitrogen balance. When excretion exceeds ingestion, a person is in a state of negative nitrogen balance. This indicates that body proteins are being broken down and used as fuel. Proteins of the muscles and liver are more easily broken down than others thus negative nitrogen balance tends to be associated with muscle atrophy. Negative nitrogen balance may occur if carbohydrate and fat intake are insufficient to meet the need for energy. Carbohydrates and fats are said to have a protein-sparing effect because they prevent protein catabolism when present in sufficient amounts to meet energy...


Phytol Tail

The core of photosynthesis is conversion of light energy to chemical energy or energy transduction. Conversion occurs when the energy in a photon of light is transferred to an electron in a light-absorbing molecule (e.g., chlorophyll). Electrons excited in this first energy-transduction step (photosystem II) are then passed through multiple carriers that undergo reversible oxidation-reduction reactions. Multiple reactions allow for a stepwise release of energy from the electrons, and as in electron transport, the released energy is coupled to synthesis of ATP. The electrons are then reexcited by absorption of light energy in a second energy-transduction step (photosystem I). The reexcited electrons can be transferred to the coenzyme nicotinamide adenine dinucleotide phosphate (NADP+) or used for other purposes. Eventually, much of the energy stored as ATP and high-energy electrons stored in NADPH will be used to convert carbon dioxide to carbohydrates (i.e., sugars) and various other...

Dental Caries

The first step in the origination of caries is the formation of a dental plaque (2). An increase in the amount of plaque is responsible for the ultimate development of gingivitis. A variety of factors interact in the generation of dental plaque and subsequent emergence of caries. These include the presence of a susceptible tooth surface, the proper microflora, and a suitable nutritional substrate for that flora. Several oral acid producing aerobic and anaerobic bacteria, including Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus, are capable of initiating the carious lesion. However, S. mutans is consistently the only organism recovered from decaying dental fissures and is isolated in greater quantities from carious teeth than in non-carious ones (9). The overwhelming majority of microorganisms isolated from carious dentin are obligate anaerobes (10). The predominant organisms are Propionibac-terium, Eubacteria, Arachnia, Lactobacillus, Bifidobacteria, and...

GHSR antagonists

Pre-prandially and fall post-prandially, indicating a possible role for the hormone as an endogenous gut-derived, orexigenic signal. In the past year, it has been shown that ghrelin and GHSR KO mice are resistant to weight gain when placed on a high fat diet and that the GHSR exhibits ligand-independent activity in transiently transfected cells 57 . While there remains much unknown about ghrelin and human obesity, the abundant animal data and human data demonstrating the orexigenic effect of ghrelin, as well as its cyclical concentrations in humans linked to periods of increased food intake, support discovery of GHSR antagonists or inverse agonists for obesity treatment.


A lysosome36 (LY- so-some) (fig. 3.28a) is a package of enzymes bounded by a single unit membrane. Although often round or oval, lysosomes are extremely variable in shape. When viewed with the TEM, they often exhibit dark gray contents devoid of structure, but sometimes show crystals or parallel layers of protein. At least 50 lyso-somal enzymes have been identified. They hydrolyze proteins, nucleic acids, complex carbohydrates, phospho-lipids, and other substrates. In the liver, lysosomes break down stored glycogen to release glucose into the blood

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