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Definition: carbohydrates from The Penguin Dictionary of Science

An abundant class of biological molecules composed of carbon, with hydrogen and oxygen in a ratio of about two hydrogens and one oxygen per one carbon. Carbohydrates occur as ➤monosaccharides (such as ➤glucose), ➤disaccharides (such as ➤sucrose), ➤oligosaccharides and ➤polysaccharides (such as ➤starch) and are a principal source of energy intake for humans.


Summary Article: CARBOHYDRATES from Encyclopedia of Wellness

In all probability, you are already aware that carbohydrates are a category of food. After all, just about all types of foods, except pure vegetable oil, contain some carbohydrates. Even foods that appear to be carbohydrate free—such as meat and fish—have small amounts. Examples of foods with higher amounts of carbohydrates are potatoes, beans, breads, milk, corn, and soft drinks. Carbohydrates come in a variety of forms, such as sugars, starches, and fibers.

People frequently divide carbohydrates into two groups—simple or complex. Simple carbohydrates are those that contain one or two types of sugar. Examples are fruit sugar (fructose), table sugar (sucrose), and corn sugar (dextrose). Complex carbohydrates have three or more types of sugars. Examples of complex carbohydrates are lentils, kidney beans, and yams.

However, it is now known that such differences in carbohydrates are not as precise or significant as people previously believed. Apparently, the digestive system does not differentiate between simple and complex carbohydrates. It breaks down all carbohydrates into single sugar molecules that are sufficiently small to enter the bloodstream. In addition, the digestive system converts most carbohydrates into glucose, which is also known as blood sugar. Glucose is then readily available for the body to use. So the two categories of carbohydrates may no longer be as useful as they were once thought to be, and many people consider the categories to be outdated.

It is important to note that there is one type of carbohydrate that stands apart from the rest—fiber. When fiber passes through the body, it is not broken down and not digested. Why, then, is fiber considered such a crucial component of the diet? While fiber does not provide the body with any nourishment, it does support health. As it passes through the digestive tract, soluble fiber, or the type that dissolves in water, collects fatty substances and eliminates them in stool. This is an important part of cardiovascular (heart and circulatory system) health. Moreover, soluble fiber also helps regulate how the body uses sugars. Insoluble fiber, or fiber that is unable to dissolve in water, passes through the digestive tract and keeps waste moving. Thus, it assists in the removal of waste products. So it is useful in the prevention of constipation.

The Glycemic Index

Carbohydrates such as white flour and white sugar quickly raise the amount of sugar in the blood. This elevation may be quite substantial and take place in a brief period of time. They give a sudden burst of energy. On the other hand, carbohydrates such as brown rice and beans result in more modest rises in blood sugar, and these occur over a longer, extended period of time. Energy levels remain about the same.

In the early 1980s, the glycemic index was created to address the varied ways that the body processes carbohydrates. The glycemic index classifies carbohydrates by how high and how quickly they raise blood sugar as compared to pure glucose. Foods that have a high glycemic index—foods with a score of 70 or higher—raise blood sugar very quickly; foods that are lower on the glycemic index—foods with a score of 55 or lower—are digested at a slower pace.

Brown rice and black beans are served on a plate. Both are complex carbohydrates and contribute to a modest but longer-lasting boost in blood sugar. (Paul Cowan/Dreamstime.com)

Although the glycemic index provides useful information, it does not provide the amount of digestible carbohydrate found in specific foods and the impact that these carbohydrates have on the blood sugar levels of the body. Thus, a food may have a high glycemic index but actually contain only a small amount of carbohydrates. To address this issue, researchers developed the glycemic load. The glycemic load of a food is calculated by multiplying the glycemic index of a food by the amount of carbohydrates it contains. Normally, a glycemic load of 20 or more is viewed as high; a glycemic load of 11 to 19 is thought to be medium; and a glycemic load of 10 or less is low. The glycemic index and glycemic load values for some common foods are shown in the following table.

Still, there are serious limitations to the glycemic index and glycemic load values. A relatively small number of foods have been tested. Values on the same foods may differ, and similar foods may have dissimilar values. Food preparation methods must also be factored into the mix. Food processing tends to make food easier to digest. Hence, it may raise glycemic index values for certain foods. On the other hand, when food is consumed with another food that has fiber, protein, or fat, it may lower the glycemic index. And, individuals may vary in how they digest carbohydrates. That would create individual variations in glycemic response (Nutrition Data, n.d.).

While acknowledging the limitations of the glycemic index and glycemic load values, it is nevertheless generally believed that a healthier diet should include more foods that are lower on the glycemic index and have lower glycemic loads and fewer foods with a high glycemic index and high glycemic loads. In fact, studies have found associations between diets filled with high-glycemic foods and a number of medical problems, such as Type 2 diabetes, heart disease, excess weight, macular degeneration, and colorectal cancer. But the results have not been consistent. For example, in a study published in 2007 in the Journal of the American College of Cardiology, Dutch researchers examined the association between dietary glycemic index and dietary glycemic load and risk of cardiovascular disease. The cohort (the group of people they studied) consisted of 15,714 Dutch women between the ages of 49 and 70 who did not have diabetes or cardiovascular disease at the start of the study. During the nine (plus or minus two) years of follow-up, there were 556 cases of coronary heart disease and 243 cases of cerebrovascular accident (stroke). The researchers found that “high dietary glycemic load and glycemic index increased the risk of CVD [cardiovascular disease], particularly for overweight women” (Beulens et al., 2007).

Table 1. Glycemic Index and Glycemic Load of Various Foods

Glycemic Index

Glycemic Load

Source: Nutrition Data, www.nutritiondata.com.

Peanut

14

2

Grapefruit

25

3

Potato chips

54

30

Snickers candy bar

55

35

Oatmeal

58

12

White rice

64

33

Watermelon

72

8

Popcorn

72

7

Baked potato

85

28

In an Italian study published in 2010 in the Archives of Internal Medicine, researchers conducted a similar investigation. Their cohort consisted of 47,749 men and women who were followed, on average, for almost eight years. The researchers determined that eating foods with high glycemic index and a high dietary glycemic load increased the overall risk of coronary heart disease in women but not men (Sieri et al., 2010).

In another study, published in 2009 in Metabolism, researchers from Birmingham, Alabama, and Boston fed 24 healthy but overweight or obese African American or white men either a high- or low-glycemic-index or high- or low-glycemic-load diet for four weeks. After a four-week washout period, the men ate the other type of diet for four weeks. The researchers noted that neither diet appeared to have “consistent effects on coronary heart disease” on this group of men. They speculated that the results may have been different if the diets had continued for longer periods of time (Shikany, Phadke, Redden, & Gower 2009), but there is no proof that that would have occurred.

Good Carbohydrates versus Bad Carbohydrates

For decades, a number of health care professionals have vilified carbohydrates and blamed them for a host of medical problems, including excess weight and elevated levels of body fat. Generally, proponents of low-carbohydrate diets have maintained that these diets are far more effective for weight loss. One of the first of these diets, the Atkins diet, stressed eating very low amounts of carbohydrates and higher amounts of protein and foods containing saturated fats, such as meat and cheese. And Atkins followers did lose weight. How was this accomplished? There was a serious restriction of caloric intake. Plus, people on a high-protein diet eat lower amounts of all types of carbohydrates, including refined carbohydrates such as jams, jellies, sweets, soda, white rice, and white bread. Lower-carbohydrate diets tend to be controversial. Many health care professionals believe that they are not balanced and that they compromise the overall health and well-being of the people who are dieting. And their arguments are compelling.

When the body has insufficient carbohydrates to burn for fuel, it may be forced to burn its own fat. Though this may sound useful to someone who wants to drop some weight, it may trigger a condition known as ketosis. During ketosis, the body forms ketones, which cause people to feel less hungry and lose weight. But ketosis may harm the body. It is associated with a number of serious health problems such as gout, kidney stones, and kidney failure.

As has been noted, people on high-protein diets often eat meat and dairy products that contain saturated fat. As a result, these diets may have the potential to raise the levels of cholesterol. And, although the topic is debatable, high levels of cholesterol may be associated with an increased risk of heart disease, stroke, and cancer. Furthermore, high-protein diets foster the excretion of more calcium from the bones, thus increasing the risk for loss of bone mass. Such loss may result in conditions of low bone mineralization such as osteopenia and osteoporosis, which place people at increased risk for bone fractures. In some parts of the world—including the United States, Europe, and Japan—rates of osteopenia and osteoporosis are already at record levels.

With all the problems that may occur with low-carbohydrate/high-protein diets, you might think people would shy away from them, but that is not true. Many people follow one or more of the seemingly endless varieties. A number of the books on these diets have been best-sellers. If you decide that your road to weight loss is a low-carbohydrate/high-protein diet, try to remain on the diet for a relatively short period of time—no more than a few months. Also, consume proteins that are lower in saturated (animal) fats, such as fish, lean beef, lean pork, skinless chicken or turkey, and low- or no-fat dairy products. Avoid eating large amounts of higher-fat foods such as marbleized steaks and whole-fat dairy products. Be certain to consume carbohydrates that are high in fiber, such as brown rice, beans, vegetables, and fruits. And if you are already dealing with a medi-cal problem, such as kidney or liver disease, do not begin a low-carbohydrate/high-protein diet without consulting your health care provider. You have the potential to create a serious or even life-threatening medical problem for yourself.

Carbohydrates and Diabetes-Related Illness

As noted, when a person eats a food that contains carbohydrates, the digestive system breaks the food down into sugar. The sugar then enters the bloodstream. When the increased amounts of sugar enter the bloodstream, the pancreas, an organ in the middle of the body, releases more insulin, a hormone that directs the cells to absorb the blood sugar. As the cells absorb the sugar, the levels of sugar in the blood start to fall. At that point, the pancreas releases the hormone glucagon, which signals the liver, a large organ in the upper abdomen, to release stored sugar. These interactions between insulin and glucagon enable the cells in the body, and particularly in the brain, to have an ongoing supply of blood sugar.

In some people, this system does not work as well as it should. People who have Type 1 diabetes do not produce a sufficient amount of insulin. As a result, their cells may not absorb all of the sugar. People with the far more common condition known as Type 2 diabetes tend to begin with a different medical problem known as insulin resistance. With insulin resistance, the cells fail to respond when insulin signals that they should absorb more sugar. As a result, insulin levels remain high for extended periods of time. Eventually, the production of insulin slows, and then it stops. Insulin resistance is linked to other medical problems, such as low levels of HDL (“good”) cholesterol, excess weight, high blood pressure (hypertension), and high levels of triglycerides (a type of fat) in the blood. When insulin resistance occurs with these medical problems, it is known as metabolic syndrome. It is not uncommon for metabolic syndrome to lead to cardiovascular disease, colorectal cancer, and, as has been noted, Type 2 diabetes. While people may have a genetic predisposition to these health problems, they are frequently associated with a sedentary lifestyle, obesity, and the consumption of large amounts of processed carbohydrates, which play havoc with blood sugars, and too few whole grains, which help to maintain a steadier level of blood sugars.

Refined or Processed Carbohydrates

Refined or processed carbohydrates seem to be just about everywhere—from that loaf of white bread to that box of white lasagna noodles—but why are they considered so detrimental? The problem is really what they do not contain. When carbohydrates are refined or processed, their beneficial nutrients—such as the bran, fiber, germ, vitamins, and minerals—are removed. What is left is primarily bland starch. For example, when wheat kernel is processed, the resulting white flour has only 20 percent of the original vitamins and minerals and 25 percent of the original fiber. Hence, manufacturers tend to enrich these products. That is the only way to give these depleted foods some substance. There is no doubt that whole-grain carbohydrates are better for you than refined or processed carbohydrates, and a good deal of research supports this contention.

In a study published in 2009 in Metabolism, Indian researchers examined the association between the consumption of refined grains and insulin resistance and metabolic syndrome in 2,042 people from urban south India. When the researchers compared the participants who consumed the least amount of refined grains with those who consumed the most, they found that the higher consumers were significantly more likely to have metabolic syndrome. The researchers noted that “higher intake of refined grains was associated with insulin resistance and the metabolic syndrome in this population of Asian Indians who habitually consume high-carbohydrate diets” (Radhika et al., 2009).

Researchers from Milan, Italy, investigated the association between dietary glycemic index and glycemic load and pancreatic cancer. Their findings were published in 2010 in the Annals of Epidemiology. The study included 326 people with pancreatic cancer, a rare but exceedingly deadly disease, and 652 people who served as controls. While the researchers found a positive association between the consumption of foods high on the glycemic index and pancreatic cancer, no such association was found between glycemic load and pancreatic cancer. They noted that the “consumption of sugar, candy, honey, and jam was positively associated with pancreatic cancer, whereas consumption of fruit was inversely associated” (Rossi et al., 2010).

In a study published in 2010 in the Archives of Internal Medicine, Harvard School of Public Health researchers examined the association between the consumption of white rice and brown rice and the risk of developing Type 2 diabetes in 39,765 men and 157,463 women. They found that an increased intake of white rice “was associated with a higher risk of type 2 diabetes.” At the same time, “higher brown rice intake…was associated with a lower risk of type 2 diabetes.” Why is this important? The researchers wrote that “Substitution of whole grains, including brown rice, for white rice may lower risk of type 2 diabetes.” Moreover, “these data support the recommendation that most carbohydrate intake should come from whole grains rather than refined grains to help prevent diabetes” (Sun et al., 2010).

In a study published in 2010 in Nutrition and Cancer, Pennsylvania researchers reviewed the results of different studies that examined the association between dietary patterns and colorectal cancer or adenoma (benign tumor). Although the studies differed markedly in “population characteristics, study design and methods used for characterizing dietary patterns across the different studies,” two patterns did emerge. A diet consisting of higher intakes of fruits and vegetables and a reduced intake of red and processed meat “appeared protective against colorectal adenoma and cancer incidence.” A less healthful pattern “characterized by higher intakes of red and processed meat, as well as potatoes and refined carbohydrates, may increase risk” (Miller et al., 2010).

In a hospital-based case-control study published in 2009 in the Asian Pacific Journal of Cancer Prevention, researchers from Kolkata, India, recruited 108 people treated for colorectal cancer and 324 controls. All of the participants were from the Malabar region of Kerala, India. The researchers found “that intake of beef, refined carbohydrates, and tobacco promote colorectal cancer” (Nayak, Sasi, Sreejayan, & Mandal, 2009).

Consumption of Sugar-Sweetened Drinks

There are a wide variety of sugar-sweetened beverages. Of course, there are the many types of sodas, such as Coke and Pepsi. But there are also energy drinks such as Red Bull and Monster, fruit drinks such as Kool-Aid and Hi-C, and fruit ades, such as Gatorade and lemonade. They all contain large amounts of sugar. And, according to an article published in 2009 in the Archives of Pediatrics and Adolescent Medicine, “sugary drinks are the main source of added sugar in the daily diet of children.” A 12-ounce serving of soda has “the equivalent of 10 teaspoons of sugar.” Moreover, “between 56% and 85% of children in school have at least one can of soda every day.” Clearly, the high levels of sugar in these drinks “provide a lot of calories very quickly” (Moreno, Furtner, & Rivara, 2009).

An 2008 article in Pediatrics presented a stunning finding. Researchers from New York City, Boston, and Baltimore noted that “per-capita daily caloric contribution from sugar-sweetened beverages and 100% fruit juice increased from 242 Kcal/day…in 1988–1994 to 270 Kcal/day in 1999–2004.” Moreover, “sugar-sweetened beverage intake increased from 204 to 224 kcal/day and 100% fruit juice increased from 38 to 48 kcal/day.” The researchers said that the greatest increases—about 20 percent—were seen among children between the ages of 6 and 11. While there were no changes in per capita consumption among white adolescents, significant increases were found among black and Mexican American youths. Preschool-age children tended to consume fruit drinks; adolescents were more likely to drink soda. The researchers concluded that “children and adolescents today derive 10% to 15% of total calories from sugar-sweetened beverages and 100% fruit juice.” The researchers noted that such high levels of sugar-sweetened beverage consumption contribute to the alarming and ever-growing rates of children who are overweight or obese (Wang, Bleich, & Gortmaker, 2008). In fact, it is now very common for children to be overweight or obese. And children who are overweight and obese are at increased risk for high cholesterol, Type 2 diabetes, high blood pressure, and psychiatric and social problems.

A study conducted at the New York City Department of Health and Mental Hygiene and published in 2009 in Obesity examined the association between excess weight and obesity and the consumption of sugar-sweetened beverages by 365 low-income African American preschool children between the ages of 3 and 5three and five. The children were examined at a dental clinic between 2002 and 2003; the examination was repeated two years later. During the first visit, the researchers found that 12.9 percent of the children were overweight; two years later, that figure had increased to 18.7 percent. During the first visit, the children had an obesity rate of 10.3 percent; two years later, that had increased to 20.4 percent. The researchers determined that “high consumption of sugar-sweetened beverages was significantly associated with an increased risk for obesity” (Lim et al., 2009).

And, it appears that children who drink sugar-sweetened carbonated beverages are likely to grow into adolescents who have less-than-ideal diets. In a study published in 2010 in the Journal of the American Dietetic Association, Pennsylvania researchers found that, compared to children who did not consume soda at the age of five years, children who did consume soda at the age of five years “had higher subsequent soda intake, lower milk intake, higher intake of added sugars, lower protein, fiber, vitamin D, calcium, magnesium, phosphorous, and potassium from ages 5 to 15 years” (Fiorito et al., 2010).

In another study from New York City, Boston, and Baltimore that was published in 2009 in the American Journal of Clinical Nutrition, researchers reviewed trends in the consumption of sugar-sweetened beverages by U.S. adults. The researchers learned that between the periods 1988 to 1994 and 1999 to 2004, the percentage of adults who drank sugar-sweetened beverages increased from 58 percent to 63 percent. On average, the daily consumption increased by six ounces. Consumption was highest among young adults, especially young blacks, and lowest among the elderly. The researchers noted that the consumption of sugar-sweetened beverages “comprises a considerable source of total daily intake and is the largest source of beverage calories.” Why is this important? The consumption of sugar-sweetened beverages “is highest among subgroups also at greatest risk of obesity and type 2 diabetes” (Bleich, Wang, Wang, & Gortmaker, 2009). It should therefore surprise no one that the Dietary Guidelines for Americans prepared by the United States Department of Agriculture (2011) advise Americans to reduce their intake of sugar-sweetened beverages.

Whole-Grain Carbohydrates

It is important to underscore that there is a huge difference between refined or processed carbohydrates and whole-grain carbohydrates. While refined or processed carbohydrates are primarily empty calories, whole-grain carbohydrates comprise an integral part of a healthful diet. Whole-grain carbohydrates consist of three main edible components: the endosperm, germ, and bran. The endosperm, which is the inner part of the grain, is all starch. It has very little nutritional value. However, the germ and bran have incredible amounts of nutrients. The germ contains B vitamins, vitamin E, selenium, magnesium, iron, copper, zinc, and trace minerals. In addition, it has phytochemicals. The consumption of phytochemicals has been associated with improving cardiovascular health and reductions in levels of cancer. The bran is filled with fiber, which is associated with lowering levels of cholesterol, reducing heart disease, and supporting digestive health. There is plenty of research supporting these claims.

In a randomized controlled trial published in 2010 in the Journal of the American Dietetic Association, Illinois researchers investigated whether a whole grain, ready-to-eat (RTE) oat cereal could improve the health of overweight and obese adults. At the beginning of the study, all of the participants had elevated levels of LDL (“bad”) cholesterol. The participants were divided into two groups. One group ate two daily portions of a whole-grain RTE oat cereal that contained fiber; the other ate energy-matched low-fiber foods. At the end of 12 weeks, 144 participants had completed the study. The researchers found that the group of people eating RTE oat cereal had significantly lowered levels of LDL cholesterol. While there was no difference in weight loss between the two groups, the group eating RTE oat cereal had greater decreases in waist circumference (Maki et al., 2010).

In a study published in 2010 in Circulation, researchers from the Harvard School of Public Health attempted to determine whether a diet that includes whole-grain carbohydrates (and its components cereal fiber, bran, and germ) could lower the risk of cardiovascular disease in women who had Type 2 diabetes. The researchers chronicled the diets of 7,822 women with Type 2 diabetes for up to 26 years. During this time, there were 852 documented deaths from all causes and 295 deaths from cardiovascular disease. The researchers found a significant association between consumption of whole grains and bran and reduction in death from all causes and from cardiovascular disease. Their findings, according to the researchers, “suggest a potential benefit of whole-grain intake in reducing mortality and cardiovascular risk in diabetic patients” (He et al., 2010).

Another study from the Harvard School of Public Health was published in 2009 in the American Journal of Clinical Nutrition. This time, researchers reviewed the association between the intake of whole grains and the onset of high blood pressure (hypertension) in men. The researchers studied of group of 31,684 men ranging in age from 40 to 75. When originally enrolled in the study, none of the men had high blood pressure. Over the 18 years of follow-up, a total of 9,227 cases of hypertension were reported. The men who ate the highest amounts of whole grains were 19 percent less likely to develop high blood pressure than the men who ate the lowest amounts of whole grains. Furthermore, the men who ate the most bran were 15 percent less likely to develop high blood pressure than the men who ate the least amount of bran. The researchers observed that “whole-grain intake was inversely associated with risk of hypertension” in men. Moreover, they added that “bran may play an important role in this association” (Flint et al., 2009).

In a study published in 2007 in the American Journal of Clinical Nutrition, researchers from the National Cancer Institute, National Institutes of Health in Bethesda, Maryland, reviewed the relationship between the intake of dietary fiber and whole-grain foods and invasive colorectal cancer. The cohort consisted of almost half a million men and women between the ages of 50 and 71. During the five years of follow-up, there were 2,974 cases of colorectal cancer. Though the researchers found no relationship between total dietary fiber and colorectal cancer, “whole-grain consumption was associated with a modest reduced risk” of colorectal cancer (Schatzkin et al., 2007).

On the other hand, in a randomized, crossover study published in 2010 in Nutrition Journal, researchers from the University of Minnesota compared differences in levels of antioxidants (which protect cells from free radical, unstable molecules that cause cellular damage) in subjects who consumed either refined-grain or whole-grain diets for 14 days and then ate the other diet for 14 days. The researchers found “no differences in antioxidant measures…when subjects consumed whole grain diets compared to refined grain diets” (Enright & Slavin, 2010).

Nevertheless, the overall evidence is overwhelming. Whole grains have multiple benefits. And, as has been advised by the federal government, Americans should increase their consumption of high fiber whole grain carbohydrates and lower their intake of refined grains (United States Department of Agriculture, 2011).

See also Antioxidants; Atkins, Robert C.; Cholesterol; Diabetes; Fats; Fiber.

References
  • Beulens, Joline W. J.; Leonie M. de Bruijne; Ronald P. Stolk, et al. “High Dietary Glycemic Load and Glycemic Index Increase Risk of Cardiovascular Disease among Middle-Aged Women: A Population-Based Follow-Up Study.” Journal of the American College of Cardiology 50 (2007): 14-21.
  • Bleich, Sara N.; Y. Claire Wang; Youfa Wang; Steven L. Gortmaker.Increasing Consumption of Sugar-Sweetened Beverages among US Adults: 1988-1994 to 1999-2004.” American Journal of Clinical Nutrition 89, no. 1 (January 2009): 372-81.
  • Enright, L.; J. Slavin.No Effect of 14 Day Consumption of Whole Grain Diet Compared to Refined Grain Diet on Antioxidant Measures in Healthy, Young Subjects: A Pilot Study.” Nutrition Journal 9 (March 19, 2010): 12.
  • Fiorito, L. M.; M. Marini; D. C. Mitchell, et al. “Girls’ Early Sweetened Carbonated Beverage Intake Predicts Different Patterns of Beverage and Nutrient Intake across Childhood and Adolescence.” Journal of the American Dietetic Association 110, no. 4 (April 2010): 543-50.
  • Flint, Alan J.; Frank B. Hu; Robert J. Glynn, et al. “Whole Grains and Incident Hypertension in Men.” American Journal of Clinical Nutrition 90, no. 3 (September 2009): 493-98.
  • He, M.; R. M. van Dam; E. Rimm, et al. “Whole-Grain, Cereal Fiber, Bran, and Germ Intake and the Risks of All-Cause and Cardiovascular Disease-Specific Mortality among Women with Type 2 Diabetes Mellitus.” Circulation 121, no. 20 (May 25, 2010): 2162-68.
  • Lim, S.; J. M. Zoellner; J. M. Lee, et al. “Obesity and Sugar-Sweetened Beverages in African-American Preschool Children: A Longitudinal Study.” Obesity 17, no. 6 (June 2009): 1262-68.
  • Maki, K. C.; J. M. Beiseigel; S. S. Jonnalagadda, et al. “Whole-Grain Ready-to-Eat Oat Cereal, As Part of a Dietary Program for Weight Loss, Reduces Low-Density Lipoprotein Cholesterol in Adults with Overweight and Obesity More than a Dietary Program Including Low-Fiber Control Foods.” Journal of the American Dietetic Association 110, no. 2 (February 2010): 205-14.
  • Miller, P. E.; S. M. Lesko; J. E. Muscat, et al. “Dietary Patterns and Colorectal Adenoma and Cancer Risk: A Review of the Epidemiological Evidence.” Nutrition and Cancer 62, no. 4 (May 2010): 413-24.
  • Moreno, Megan A.; Fred Furtner; Frederick P. Rivara.Sugary Drinks and Childhood Obesity.” Archives of Pediatrics and Adolescent Medicine 163, no. 4 (April 2009): 400.
  • Nayak, S. P.; M. P. Sasi; M. P. Sreejayan; S. Mandal.A Case-Control Study of Roles of Diet in Colorectal Carcinoma in a South Indian Population.” Asian Pacific Journal of Cancer Prevention 10, no. 4 (October-December 2009): 565-68.
  • Nutrition Data (n.d.), www.nutritiondata.com.
  • Radhika, G.; R. M. van Dam; V. Sudha, et al. “Refined Grain Consumption and the Metabolic Syndrome in Urban Asian Indians (Chennai Urban Rural Epidemiology Study 57).” Metabolism 58, no. 5 (May 2009): 675-81.
  • Rossi, M.; L. Lipworth; J. Polesel, et al. “Dietary Glycemic Index and Glycemic Load and Risk of Pancreatic Cancer: A Case-Control Study.” Annals of Epidemiology 20, no. 6 (June 2010): 460-65.
  • Schatzkin, A.; T. Mouw; Y. Park, et al. “Dietary Fiber and Whole-Grain Consumption in Relation to Colorectal Cancer in the NIH-AARP Diet and Health Study.” American Journal of Clinical Nutrition 85, no. 5 (May 2007): 1353-60.
  • Shikany, James M.; Radhika P. Phadke; David T. Redden; Barbara A. Gower.Effects of Low- and High-Glycemic Load Diets on Coronary Heart Disease Risk Factors in Overweight/Obese Men.” Metabolism 58, no. 12 (December 2009): 1793-801.
  • Sieri, Sabina; Vittorio Krogh; Franco Berrino, et al. “Dietary Glycemic Load and Index and Risk of Coronary Heart Disease in a Large Italian Cohort: The EPICOR Study.” Archives of Internal Medicine 170, no. 7 (April 12, 2010): 640-47.
  • Sun, Q.; D. Spiegelman; R. M. van Dam, et al. “White Rice, Brown Rice, and Risk of Type 2 Diabetes in US Men and Women.” Archives of Internal Medicine 170, no. 11 (June 14, 2010): 961-69.
  • United States Department of Agriculture Center for Nutrition Policy and Promotion. Dietary Guidelines for Americans, 2010 (January 31, 2011), www.cnpp.usda.gov/dietaryguidelines.htm.
  • Wang, Y. Claire; Sara N. Bleich; Steven L. Gortmaker.Increasing Caloric Contribution from Sugar-Sweetened Beverages and 100% Fruit Juices among US Children and Adolescents, 1998-2004.” Pediatrics 121, no. 6 (June 2008): e1604-e1614.
  • Myrna Chandler Goldstein
    Copyright 2012 by Sharon Zoumbaris

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