The right carbohydrates can be a great nutrient to meet your body’s nutritional needs. They nourish your brain and nervous system, provide energy to all of your cells when within proper caloric limits, and help keep your body fit and lean. Specifically, digestible carbohydrates provide bulk in foods, vitamins, and minerals, while indigestible carbohydrates provide a good amount of fiber with a host of other health benefits.

Plants synthesize the fast-releasing carbohydrate, glucose, from carbon dioxide in the air and water, and by harnessing the sun’s energy. Recall that plants convert the energy in sunlight to chemical energy in the molecule, glucose. Plants use glucose to make other larger, more slow-releasing carbohydrates. When we eat plants we harvest the energy of glucose to support life’s processes.

Carbohydrates are a group of organic compounds containing a ratio of one carbon atom to two hydrogen atoms to one oxygen atom. Basically, they are hydrated carbons. The word “carbo” means carbon and “hydrate” means water. Glucose, the most abundant carbohydrate in the human body, has six carbon atoms, twelve hydrogen atoms, and six oxygen atoms. The chemical formula for glucose is written as C6H12O6. Synonymous with the term carbohydrate is the Greek word “saccharide,” which means sugar. Carbohydrates are broadly classified into two subgroups, simple (“fast-releasing”) and complex (“slow-releasing”). Simple carbohydrates are further grouped into the monosaccharides and disaccharides. Complex carbohydrates are long chains of monosaccharides.

Figure 4.1 Carbohydrate Classification Scheme

Carbohydrates are broken down into the subgroups simple and complex carbohydrates. These subgroups are further categorized into mono-, di-, and polysaccharides.

Simple/Fast-Releasing Carbohydrates

Simple carbohydrates are also known more simply as “sugars” and are grouped as either monosaccharides or disaccharides. Monosaccharides include glucosefructose, and galactose, and the disaccharides include lactosemaltose, and sucrose.

Simple carbohydrates stimulate the sweetness taste sensation, which is the most sensitive of all taste sensations. Even extremely low concentrations of sugars in foods will stimulate the sweetness taste sensation. Sweetness varies between the different carbohydrate types—some are much sweeter than others. Fructose is the top naturally-occurring sugar in sweetness value.


For all organisms from bacteria to plants to animals, glucose is the preferred fuel source. The brain is completely dependent on glucose as its energy source (except during extreme starvation conditions). The monosaccharide galactose differs from glucose only in that a hydroxyl (−OH) group faces in a different direction on the number four carbon (Figure 4.2 “Structures of the Three Most Common Monosaccharides: Glucose, Galactose, and Fructose”). This small structural alteration causes galactose to be less stable than glucose. As a result, the liver rapidly converts it to glucose. Most absorbed galactose is utilized for energy production in cells after its conversion to glucose. (Galactose is one of two simple sugars that are bound together to make up the sugar found in milk. It is later freed during the digestion process.)

Fructose also has the same chemical formula as glucose but differs in its chemical structure, as the ring structure contains only five carbons and not six. Fructose, in contrast to glucose, is not an energy source for other cells in the body. Mostly found in fruits, honey, and sugarcane, fructose is one of the most common monosaccharides in nature. It is also found in soft drinks, cereals, and other products sweetened with high fructose corn syrup.

Figure 4.2 Structures of the Three Most Common Monosaccharides: Glucose, Galactose, and Fructose

Circles indicate the structural differences between the three.

Pentoses are less common monosaccharides which have only five carbons and not six. The pentoses are abundant in the nucleic acids RNA and DNA, and also as components of fiber.

Lastly, there are the sugar alcohols, which are industrially synthesized derivatives of monosaccharides. Some examples of sugar alcohols are sorbitol, xylitol, and glycerol. (Xylitol is similar in sweetness as table sugar). Sugar alcohols are often used in place of table sugar to sweeten foods as they are incompletely digested and absorbed, and therefore less caloric. The bacteria in your mouth opposes them, hence sugar alcohols do not cause tooth decay. Interestingly, the sensation of “coolness” that occurs when chewing gum that contains sugar alcohols comes from them dissolving in the mouth, a chemical reaction that requires heat from the inside of the mouth.


Disaccharides are composed of pairs of two monosaccharides linked together. Disaccharides include sucrose, lactose, and maltose. All of the disaccharides contain at least one glucose molecule.

Sucrose, which contains both glucose and fructose molecules, is otherwise known as table sugar. Sucrose is also found in many fruits and vegetables, and at high concentrations in sugar beets and sugarcane, which are used to make table sugar. Lactose, which is commonly known as milk sugar, is composed of one glucose unit and one galactose unit. Lactose is prevalent in dairy products such as milk, yogurt, and cheese. Maltose consists of two glucose molecules bonded together. It is a common breakdown product of plant starches and is rarely found in foods as a disaccharide.

Figure 4.3 The Most Common Disaccharides

Image by Allison Calabrese /
CC BY 4.0

Complex/Slow-Releasing Carbohydrates

Complex carbohydrates are polysaccharides, long chains of monosaccharides that may be branched or not branched. There are two main groups of polysaccharides: starches and fibers.


Starch molecules are found in abundance in grains, legumes, and root vegetables, such as potatoes. Amylose, a plant starch, is a linear chain containing hundreds of glucose units. Amylopectin, another plant starch, is a branched chain containing thousands of glucose units. These large starch molecules form crystals and are the energy-storing molecules of plants. These two starch molecules (amylose and amylopectin) are contained together in foods, but the smaller one, amylose, is less abundant. Eating raw foods containing starches provides very little energy as the digestive system has a hard time breaking them down. Cooking breaks down the crystal structure of starches, making them much easier to break down in the human body. The starches that remain intact throughout digestion are called resistant starches. Bacteria in the gut can break some of these down and may benefit gastrointestinal health. Isolated and modified starches are used widely in the food industry and during cooking as food thickeners.

Humans and animals store glucose energy from starches in the form of the very large molecule, glycogen. It has many branches that allow it to break down quickly when energy is needed by cells in the body. It is predominantly found in liver and muscle tissue in animals.

Figure 4.4 Structures of the Plant Starches and Glycogen

Dietary Fibers

Dietary fibers are polysaccharides that are highly branched and cross-linked. Some dietary fibers are pectin, gums, cellulose, hemicellulose, and lignin. Lignin, however, is not composed of carbohydrate units. Humans do not produce the enzymes that can break down dietary fiber; however, bacteria in the large intestine (colon) do. Dietary fibers are very beneficial to our health. The Dietary Guidelines Advisory Committee states that there is enough scientific evidence to support that diets high in fiber reduce the risk for obesity and diabetes, which are primary risk factors for cardiovascular disease.[2]

Dietary fiber is categorized as either water-soluble or insoluble. Some examples of soluble fibers are inulin, pectin, and guar gum and they are found in peas, beans, oats, barley, and rye. Cellulose and lignin are insoluble fibers and a few dietary sources of them are whole-grain foods, flax, cauliflower, and avocados. Cellulose is the most abundant fiber in plants, making up the cell walls and providing structure. Soluble fibers are more easily accessible to bacterial enzymes in the large intestine so they can be broken down to a greater extent than insoluble fibers, but even some breakdown of cellulose and other insoluble fibers occurs.

The last class of fiber is functional fiber. Functional fibers have been added to foods and have been shown to provide health benefits to humans. Functional fibers may be extracted from plants and purified or synthetically made. An example of a functional fiber is psyllium-seed husk. Scientific studies show that consuming psyllium-seed husk reduces blood-cholesterol levels and this health claim has been approved by the FDA. Total dietary fiber intake is the sum of dietary fiber and functional fiber consumed.

Figure 4.5 Dietary Fiber

Image by Allison Calabrese / CC BY 4.0

Digestion and Absorption of Carbohydrates

From the Mouth to the Stomach

The mechanical and chemical digestion of carbohydrates begins in the mouth. Chewing, also known as mastication, crumbles the carbohydrate foods into smaller and smaller pieces. The salivary glands in the oral cavity secrete saliva that coats the food particles. Saliva contains the enzyme, salivary amylase. This enzyme breaks the bonds between the monomeric sugar units of disaccharides, oligosaccharides, and starches. The salivary amylase breaks down amylose and amylopectin into smaller chains of glucose, called dextrins and maltose. The increased concentration of maltose in the mouth that results from the mechanical and chemical breakdown of starches in whole grains is what enhances their sweetness. Only about five percent of starches are broken down in the mouth. (This is a good thing as more glucose in the mouth would lead to more tooth decay.) When carbohydrates reach the stomach no further chemical breakdown occurs because the amylase enzyme does not function in the acidic conditions of the stomach. But mechanical breakdown is ongoing—the strong peristaltic contractions of the stomach mix the carbohydrates into the more uniform mixture of chyme.

Figure 4.6 Salivary Glands in the Mouth

Salivary glands secrete salivary amylase, which begins the chemical breakdown of carbohydrates by breaking the bonds between monomeric sugar units.

From the Stomach to the Small Intestine

The chyme is gradually expelled into the upper part of the small intestine. Upon entry of the chyme into the small intestine, the pancreas releases pancreatic juice through a duct. This pancreatic juice contains the enzyme, pancreatic amylase, which starts again the breakdown of dextrins into shorter and shorter carbohydrate chains. Additionally, enzymes are secreted by the intestinal cells that line the villi. These enzymes, known collectively as disaccharidase, are sucrase, maltase, and lactase. Sucrase breaks sucrose into glucose and fructose molecules. Maltase breaks the bond between the two glucose units of maltose, and lactase breaks the bond between galactose and glucose. Once carbohydrates are chemically broken down into single sugar units they are then transported into the inside of intestinal cells.

When people do not have enough of the enzyme lactase, lactose is not sufficiently broken down (to galactose and glucose) resulting in a condition called lactose intolerance. The undigested lactose moves to the large intestine where bacteria are able to digest it. The bacterial digestion of lactose produces gases leading to symptoms of diarrhea, bloating, and abdominal cramps. Lactose intolerance usually occurs in adults and is associated with race. People of non-European descent, especially Asians, have much higher incidences of lactose intolerance while those of northern European descent have the least. Most people with lactose intolerance can tolerate some amount of dairy products in their diet. The severity of the symptoms depends on how much lactose is consumed and the degree of lactase deficiency.

Absorption: Going to the Blood Stream

The cells in the small intestine have membranes that contain many transport proteins in order to get the monosaccharides and other nutrients into the blood where they can be distributed to the rest of the body. The first organ to receive glucose, fructose, and galactose is the liver. The liver takes them up and converts galactose to glucose, breaks fructose into even smaller carbon-containing units, and either stores glucose as glycogen or exports it back to the blood. How much glucose the liver exports to the blood is under hormonal control and you will soon discover that even the glucose itself regulates its concentrations in the blood.

Figure 4.7 Carbohydrate Digestion

Carbohydrate digestion begins in the mouth and is most extensive in the small intestine. The resultant monosaccharides are absorbed into the bloodstream and transported to the liver.

Maintaining Blood Glucose Levels: the Pancreas and Liver

Glucose levels in the blood are tightly controlled, as having either too much or too little glucose in the blood can have health consequences. Glucose regulates its levels in the blood via a process called negative feedback. The body senses blood glucose levels and maintains the glucose “temperature” in the target range. The glucose thermostat is located within the cells of the pancreas. After eating a meal containing carbohydrates glucose levels rise in the blood.

Insulin-secreting cells in the pancreas sense the increase in blood glucose and release the hormone, insulin, into the blood. Insulin sends a signal to the body’s cells to remove glucose from the blood by transporting it into different organ cells around the body and using it to make energy. In the case of muscle tissue and the liver, insulin sends the biological message to store glucose away as glycogen. The presence of insulin in the blood signifies to the body that glucose is available for fuel. As glucose is transported into the cells around the body, the blood glucose levels decrease. Insulin has an opposing hormone called glucagon. Glucagon-secreting cells in the pancreas sense the drop in glucose and, in response, release glucagon into the blood. Glucagon communicates to the cells in the body to stop using all the glucose. More specifically, it signals the liver to break down glycogen and release the stored glucose into the blood, so that glucose levels stay within the target range and all cells get the needed fuel to function properly.

Figure 4.8 The Regulation of Glucose

Image by Allison Calabrese / CC BY 4.0

Leftover Carbohydrates: the Large Intestine

Almost all of the carbohydrates, except for dietary fiber and resistant starches, are efficiently digested and absorbed into the body. Some of the remaining indigestible carbohydrates are broken down by enzymes released by bacteria in the large intestine. The products of bacterial digestion of these slow-releasing carbohydrates are short-chain fatty acids and some gases. The short-chain fatty acids are either used by the bacteria to make energy and grow, are eliminated in the feces, or are absorbed into cells of the colon, with a small amount being transported to the liver. Colonic cells use the short-chain fatty acids to support some of their functions. The liver can also metabolize the short-chain fatty acids into cellular energy. The yield of energy from dietary fiber is about 2 kilocalories per gram for humans, but is highly dependent upon the fiber type, with soluble fibers and resistant starches yielding more energy than insoluble fibers. Since dietary fiber is digested much less in the gastrointestinal tract than other carbohydrate types (simple sugars, many starches) the rise in blood glucose after eating them is less, and slower. These physiological attributes of high-fiber foods (i.e. whole grains) are linked to a decrease in weight gain and reduced risk of chronic diseases, such as Type 2 diabetes and cardiovascular disease.

Figure 4.9 Overview of Carbohydrate Digestion

Image by Allison Calabrese /
CC BY 4.0

A typical or average Western diet contains foods that are dense in carbohydrates, with the majority of those being simple sugars and starches. These types of carbohydrate foods are rapidly digested and absorbed. Blood glucose levels rise quickly causing a spike in insulin levels. Contrastingly, foods containing high amounts of fiber are like time-release capsules of sugar. A measurement of the effects of a carbohydrate-containing food on blood-glucose levels is called the glycemic response.

Glycemic Index

The glycemic responses of various foods have been measured and then ranked in comparison to a reference food, usually a slice of white bread or just straight glucose, to create a numeric value called the glycemic index (GI). Foods that have a low GI do not raise blood-glucose levels neither as much nor as fast as foods that have a higher GI. A diet of low-GI foods has been shown in epidemiological and clinical trial studies to increase weight loss and reduce the risk of obesity, Type 2 diabetes, and cardiovascular disease.

Table 4.1 The Glycemic Index: Foods In Comparison To Glucose

Foods GI Value
Low GI Foods (< 55)
Apple, raw 36
Orange, raw 43
Banana, raw 51
Mango, raw 51
Carrots, boiled 39
Taro, boiled 53
Corn tortilla 46
Spaghetti (whole wheat) 37
Baked beans 48
Soy milk 34
Skim milk 37
Whole milk 39
Yogurt, fruit 41
Yogurt, plain 14
Icecream 51
Medium GI Foods (56–69)
Pineapple, raw 59
Cantaloupe 65
Mashed potatoes 70
Whole-wheat bread 69
Brown rice 55
Cheese pizza 60
Sweet potato, boiled 63
Macaroni and cheese 64
Popcorn 65
High GI Foods (70 and higher)
Banana (over-ripe) 82
Corn chips 72
Pretzels 83
White bread 70
White rice 72
Bagel 72
Rice milk 86
Cheerios 74
Raisin Bran 73
Fruit roll-up 99
Gatorade 78

The type of carbohydrate within a food affects the GI along with its fat and fiber content. Increased fat and fiber in foods increases the time required for digestion and delays the rate of gastric emptying into the small intestine which, ultimately reduces the GI. Processing and cooking also affects a food’s GI by increasing their digestibility. Advancements in the technologies of food processing and the high consumer demand for convenient, precooked foods in the United States has created foods that are digested and absorbed more rapidly, independent of the fiber content. Modern breakfast cereals, breads, pastas, and many prepared foods have a high GI. In contrast, most raw foods have a lower GI. (However, the more ripened a fruit or vegetable is, the higher its GI.)

The GI can be used as a guide for choosing healthier carbohydrate choices but has some limitations. The first is GI does not take into account the amount of carbohydrates in a portion of food, only the type of carbohydrate. Another is that combining low- and high-GI foods changes the GI for the meal. Also, some nutrient-dense foods have higher GIs than less nutritious food. (For instance, oatmeal has a higher GI than chocolate because the fat content of chocolate is higher.) Lastly, meats and fats do not have a GI since they do not contain carbohydrates.

The Functions of Carbohydrates in the Body

There are five primary functions of carbohydrates in the human body. They are energy production, energy storage, building macromolecules, sparing protein, and assisting in lipid metabolism.

Energy Production

The primary role of carbohydrates is to supply energy to all cells in the body. Many cells prefer glucose as a source of energy versus other compounds like fatty acids. Some cells, such as red blood cells, are only able to produce cellular energy from glucose. The brain is also highly sensitive to low blood-glucose levels because it uses only glucose to produce energy and function (unless under extreme starvation conditions). About 70 percent of the glucose entering the body from digestion is redistributed (by the liver) back into the blood for use by other tissues. Cells that require energy remove the glucose from the blood with a transport protein in their membranes. The energy from glucose comes from the chemical bonds between the carbon atoms. Sunlight energy was required to produce these high-energy bonds in the process of photosynthesis. Cells in our bodies break these bonds and capture the energy to perform cellular respiration. Cellular respiration is basically a controlled burning of glucose versus an uncontrolled burning. A cell uses many chemical reactions in multiple enzymatic steps to slow the release of energy (no explosion) and more efficiently capture the energy held within the chemical bonds in glucose.

The first stage in the breakdown of glucose is called glycolysis. Glycolysis, or the splitting of glucose, occurs in an intricate series of ten enzymatic-reaction steps. The second stage of glucose breakdown occurs in the energy factory organelles, called mitochondria. One carbon atom and two oxygen atoms are removed, yielding more energy. The energy from these carbon bonds is carried to another area of the mitochondria, making the cellular energy available in a form cells can use.

Figure 4.10 Cellular Respiration

Cellular respiration is the process by which energy is captured from glucose.

Energy Storage

If the body already has enough energy to support its functions, the excess glucose is stored as glycogen (the majority of which is stored in the muscles and liver). A molecule of glycogen may contain in excess of fifty thousand single glucose units and is highly branched, allowing for the rapid dissemination of glucose when it is needed to make cellular energy.

The amount of glycogen in the body at any one time is equivalent to about 4,000 kilocalories—3,000 in muscle tissue and 1,000 in the liver. Prolonged muscle use (such as exercise for longer than a few hours) can deplete the glycogen energy reserve. Remember that this is referred to as “hitting the wall” or “bonking” and is characterized by fatigue and a decrease in exercise performance. The weakening of muscles sets in because it takes longer to transform the chemical energy in fatty acids and proteins to usable energy than glucose. After prolonged exercise, glycogen is gone and muscles must rely more on lipids and proteins as an energy source. Athletes can increase their glycogen reserve modestly by reducing training intensity and increasing their carbohydrate intake to between 60 and 70 percent of total calories three to five days prior to an event. People who are not hardcore training and choose to run a 5-kilometer race for fun do not need to consume a big plate of pasta prior to a race since without long-term intense training the adaptation of increased muscle glycogen will not happen.

The liver, like muscle, can store glucose energy as a glycogen, but in contrast to muscle tissue it will sacrifice its stored glucose energy to other tissues in the body when blood glucose is low. Approximately one-quarter of total body glycogen content is in the liver (which is equivalent to about a four-hour supply of glucose) but this is highly dependent on activity level. The liver uses this glycogen reserve as a way to keep blood-glucose levels within a narrow range between meal times. When the liver’s glycogen supply is exhausted, glucose is made from amino acids obtained from the destruction of proteins in order to maintain metabolic homeostasis.

Building Macromolecules

Although most absorbed glucose is used to make energy, some glucose is converted to ribose and deoxyribose, which are essential building blocks of important macromolecules, such as RNA, DNA, and ATP. Glucose is additionally utilized to make the molecule NADPH, which is important for protection against oxidative stress and is used in many other chemical reactions in the body. If all of the energy, glycogen-storing capacity, and building needs of the body are met, excess glucose can be used to make fat. This is why a diet too high in carbohydrates and calories can add on the fat pounds.

Figure 4.11 Chemical Structure of Deoxyribose

The sugar molecule deoxyribose is used to build the backbone of DNA. Image by rozeta / CC BY-SA 3.0


Figure 4.12 Double-stranded DNA

Image by Forluvoft / Public Domain

Sparing Protein

In a situation where there is not enough glucose to meet the body’s needs, glucose is synthesized from amino acids. Because there is no storage molecule of amino acids, this process requires the destruction of proteins, primarily from muscle tissue. The presence of adequate glucose basically spares the breakdown of proteins from being used to make glucose needed by the body.

Lipid Metabolism

As blood-glucose levels rise, the use of lipids as an energy source is inhibited. Thus, glucose additionally has a “fat-sparing” effect. This is because an increase in blood glucose stimulates release of the hormone insulin, which tells cells to use glucose (instead of lipids) to make energy. Adequate glucose levels in the blood also prevent the development of ketosis. Ketosis is a metabolic condition resulting from an elevation of ketone bodies in the blood. Ketone bodies are an alternative energy source that cells can use when glucose supply is insufficient, such as during fasting. Ketone bodies are acidic and high elevations in the blood can cause it to become too acidic. This is rare in healthy adults, but can occur in alcoholics, people who are malnourished, and in individuals who have uncontrolled diabetes. The minimum amount of carbohydrate in the diet required to inhibit ketosis in adults is 50 grams per day.

Carbohydrates are critical to support life’s most basic function—the production of energy. Without energy none of the other life processes are performed. Although our bodies can synthesize glucose it comes at the cost of protein destruction. As with all nutrients though, carbohydrates are to be consumed in moderation as having too much or too little in the diet may lead to health problems.


Health Consequences and Benefits of High-Carbohydrate Diets

Can America blame its obesity epidemic on the higher consumption of added sugars and refined grains? This is a hotly debated topic by both the scientific community and the general public. In this section, a brief overview of the scientific evidence is presented.

Added Sugars

Figure 4.13 Sugar Consumption (In Teaspoons) From Various Sources

The Food and Nutrition Board of the Institute of Medicine (IOM) defines added sugars as “sugars and syrups that are added to foods during processing or preparation.” The IOM goes on to state, “Major sources of added sugars include soft drinks, sports drinks, cakes, cookies, pies, fruitades, fruit punch, dairy desserts, and candy.” Processed foods, even microwaveable dinners, also contain added sugars. Added sugars do not include sugars that occur naturally in whole foods (such as an apple), but do include natural sugars such as brown sugar, corn syrup, dextrose, fructose, fruit juice concentrates, maple syrup, sucrose, and raw sugar that are then added to create other foods (such as cookies). Results from a survey of forty-two thousand Americans reports that in 2008 the average intake of added sugars is 15 percent of total calories, a drop from 18 percent of total calories in 2000.[1]

This is still above the recommended intake of less than 10 percent of total calories. The US Department of Agriculture (USDA) reports that sugar consumption in the American diet in 2008 was, on average, 28 teaspoons per day (Figure 4.13 “Sugar Consumption (in Teaspoons) from Various Sources”).

Obesity, Diabetes, and Heart Disease and their Hypothesized Link to Excessive Sugar and Refined Carbohydrate Consumption

To understand the magnitude of the health problem in the United States consider that in the United States approximately 130 million adults are overweight, and 30 percent of them are considered obese. The obesity epidemic has reached young adults and children and will markedly affect the prevalence of serious health consequences in adulthood. Health consequences linked to being overweight or obese include Type 2 diabetes, cardiovascular disease, arthritis, depression, and some cancers. An infatuation with sugary foods and refined grains likely contributes to the epidemic proportion of people who are overweight or obese in this country, but so do the consumption of high-calorie foods that contain too much saturated fat and the sedentary lifestyle of most Americans. There is much disagreement over whether high-carbohydrate diets increase weight-gain and disease risk, especially when calories are not significantly higher between compared diets. Many scientific studies demonstrate positive correlations between diets high in added sugars with weight gain and disease risk, but some others do not show a significant relationship. In regard to refined grains, there are no studies that show consumption of refined grains increases weight gain or disease risk. What is clear, however, is that getting more of your carbohydrates from dietary sources containing whole grains instead of refined grains stimulates weight loss and reduces disease risk.

A major source of added sugars in the Western diet is soft drinks. There is consistent scientific evidence that consuming sugary soft drinks increases weight gain and disease risk. An analysis of over thirty studies in the American Journal of Clinical Nutrition concluded that there is much evidence to indicate higher consumption of sugar-sweetened beverages is linked with weight gain and obesity.[2] A study at the Harvard School of Public Health linked the consumption of sugary soft drinks to an increased risk for heart disease.[3]

While the sugar and refined grains and weight debate rages on, the results of all of these studies has led some public health organizations like the American Heart Association (AHA) to recommend even a lower intake of sugar per day (fewer than 9 teaspoons per day for men and fewer than 6 teaspoons for women) than what used to be deemed acceptable. After its 2010 scientific conference on added sugars, the AHA made the following related dietary recommendations[4]:

  • First, know the number of total calories you should eat each day.
  • Consume an overall healthy diet and get the most nutrients for the calories, using foods high in added sugars as discretionary calories (those left over after getting all recommended nutrients subtracted from the calories used).
  • Lower sugar intake, especially when the sugars in foods are not tied to positive nutrients such as in sugary drinks, candies, cakes, and cookies.
  • Focus on calories in certain food categories such as beverages and confections, and encourage consumption of positive nutrients and foods such as cereals and low-fat or fat-free dairy products.

The Most Notorious Sugar

Before high-fructose corn syrup (HFCS) was marketed as the best food and beverage sweetener, sucrose (table sugar) was the number-one sweetener in America. (Recall that sucrose, or table sugar, is a disaccharide consisting of one glucose unit and one fructose unit.) HFCS also contains the simple sugars fructose and glucose, but with fructose at a slightly higher concentration. In the production of HFCS, corn starch is broken down to glucose, and some of the glucose is then converted to fructose. Fructose is sweeter than glucose; hence many food manufacturers choose to sweeten foods with HFCS. HFCS is used as a sweetener for carbonated beverages, condiments, cereals, and a great variety of other processed foods.

Some scientists, public health personnel, and healthcare providers believe that fructose is the cause of the obesity epidemic and its associated health consequences. The majority of their evidence stems from the observation that since the early 1970s the number of overweight or obese Americans has dramatically increased and so has the consumption of foods containing HFCS. However, as discussed, so has the consumption of added sugars in general. Animal studies that fuel the fructose opponents show fructose is not used to produce energy in the body; instead it is mostly converted to fat in the liver—potentially contributing to insulin resistance and the development of Type 2 diabetes. Additionally, fructose does not stimulate the release of certain appetite-suppressing hormones, like insulin, as glucose does. Thus, a diet high in fructose could potentially stimulate fat deposition and weight gain.

In human studies, excessive fructose intake has sometimes been associated with weight gain, but results are inconsistent. Moderate fructose intake is not associated with weight gain at all. Moreover, other studies show that some fructose in the diet actually improves glucose metabolism especially in people with Type 2 diabetes.[5]

In fact, people with diabetes were once advised to use fructose as an alternative sweetener to table sugar. Overall, there is no good evidence that moderate fructose consumption contributes to weight gain and chronic disease. At this time conclusive evidence is not available on whether fructose is any worse than any other added sugar in increasing the risk for obesity, Type 2 diabetes, and cardiovascular disease.

Do Low-Carbohydrate Diets Affect Health?

Since the early 1990s, marketers of low-carbohydrate diets have bombarded us with the idea that eating fewer carbohydrates promotes weight loss and that these diets are superior to others in their effects on weight loss and overall health. The most famous of these low-carbohydrate diets is the Atkins diet. Others include the “South Beach” diet, the “Zone” diet, and the “Earth” diet. Despite the claims these diets make, there is little scientific evidence to support that low-carbohydrate diets are significantly better than other diets in promoting long-term weight loss. A study in The Nutritional Journal concluded that all diets, (independent of carbohydrate, fat, and protein content) that incorporated an exercise regimen significantly decreased weight and waist circumference in obese women.[6]

Some studies do provide evidence that in comparison to other diets, low-carbohydrate diets improve insulin levels and other risk factors for Type 2 diabetes and cardiovascular disease. The overall scientific consensus is that consuming fewer calories in a balanced diet will promote health and stimulate weight loss, with significantly better results achieved when combined with regular exercise.

Health Benefits of Whole Grains in the Diet

While excessive consumption of simple carbohydrates is potentially bad for your health, consuming more complex carbohydrates is extremely beneficial to health. There is a wealth of scientific evidence supporting that replacing refined grains with whole grains decreases the risk for obesity, Type 2 diabetes, and cardiovascular disease. Whole grains are great dietary sources of fiber, vitamins, minerals, healthy fats, and a vast amount of beneficial plant chemicals, all of which contribute to the effects of whole grains on health. Eating a high-fiber meal as compared to a low-fiber meal (see Figure 4.14 “Fibers Role in Carbohydrate Digestion and Absorption”) can significantly slow down the absorption process therefore affecting blood glucose levels.  Americans typically do not consume the recommended amount of whole grains, which is 50 percent or more of grains from whole grains.

Figure 4.14 Fibers Role in Carbohydrate Digestion and Absorption

Image by Allison Calabrese / CC BY 4.0

Diets high in whole grains have repeatedly been shown to decrease weight. A large group of studies all support that consuming more than two servings of whole grains per day reduces one’s chances of getting Type 2 diabetes by 21 percent.[7] The Nurses’ Health Study found that women who consumed two to three servings of whole grain products daily were 30 percent less likely to have a heart attack.[8]

The AHA makes the following statements on whole grains[9]:

  • “Dietary fiber from whole grains, as part of an overall healthy diet, helps reduce blood cholesterol levels and may lower risk of heart disease.”
  • “Fiber-containing foods, such as whole grains, help provide a feeling of fullness with fewer calories and may help with weight management.”

Figure 4.15 Grain Consumption Statistics in America

Source: Economic Research Service.


  1. Welsh JA, Sharma AJ, et al. Consumption of Added Sugars Is Decreasing in the United States. Am J Clin Nutr. 2011; 94(3), 726–34. Accessed September 22, 2017.
  2. Malik VS, Schulze MB, Hu FB. Intake of Sugar-Sweetened Beverages and Weight Gain: A Systematic Review. Am J Clin Nutr. 2006; 84(2), 274–88. Accessed September 22, 2017.
  3. Public Health Takes Aim at Sugar and Salt. Harvard School of Public Health. Published 2009. Accessed September 30, 2017. 
  4. Van Horn L, Johnson RK, et al.Translation and Implementation of Added Sugars Consumption Recommendations. Circulation. 2010; 122, 2470–90. Accessed September 27, 2017.
  5. Elliott SS, Keim NL, et al. Fructose, Weight Gain, and the Insulin Resistance Syndrome. Am J Clin Nutr. 2002; 76(5),911–22. Accessed September 27, 2017. 
  6. Kerksick CM, Wismann-Bunn J, et al. Changes in Weight Loss, Body Composition, and Cardiovascular Disease Risk after Altering Macronutrient Distributions During a Regular Exercise Program in Obese Women. J Nutr. 2010; 9(59). Accessed September 27, 2017.
  7. de Munter JS, Hu FB, et al. Whole Grain, Bran, and Germ Intake and Risk of Type 2 Diabetes: A Prospective Cohort Study and Systematic Review. PLoS Medicine. 2007; 4(8), e261. Accessed September 27, 2017.
  8. Liu S, Stampfer MJ, et al. Whole-Grain Consumption and Risk of Coronary Heart Disease: Results from the Nurses’ Health Study. Am J Clin Nutr. 1999; 70(3), 412–19. Accessed September 27, 2017.
  9. Whole Grains and Fiber. American Heart Association. Updated 2017. Accessed September 30, 2017.


Creative Commons License


Creative Commons Attribution 4.0 International License

This part contains content from OpenStax College, Anatomy and Physiology. OpenStax CNX. Download for free at

University of Hawai‘i at Mānoa Food Science and Human Nutrition Program is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License, except where otherwise noted.

This resource has been adapted from: OpenStax Anatomy and Physiology // CC BY 4.0

  • Chapter 2 The Human Body

An Introduction to Human Nutrition // CC BY-NC-SA 3.0

  • Chapter 1 Basic Concepts in Nutrition
  • Chapter 3 Water and Electrolytes
  • Chapter 4 Carbohydrates
  • Chapter 5 Lipids
  • Chapter 6 Protein
  • Chapter 8 Energy
  • Chapter 12 Nutrition Applications
  • Chapter 13 Lifespan Nutrition From Pregnancy to the Toddler Years
  • Chapter 14 Lifespan Nutrition During Childhood and Adolescence
  • Chapter 15 Lifespan Nutrition in Adulthood
  • Chapter 17 Food Safety
  • Chapter 18 Nutritional Issues

Chapters and sections were borrowed and adapted from the above existing OER textbooks on human nutrition. Without these foundational texts, a lot more work would have been required to complete this project. Thank you to those who shared before us.

SA Bos, M.D.

Lead Author