Citazione Originariamente Scritto da tattoos
Per ulteriore discussione per ciò che riguarda i carboidrati, riporto questo:

CARBOIDRATI E FIBRA ALIMENTARE
Fonte: Società Italiana di Nutrizione Umana (1996). LARN, Livelli di Assunzione Raccomandati di Energia e Nutrienti per la Popolazione Italiana. Roma: Istituto Nazionale della Nutrizione.

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Carboidrati disponibili

E’ noto che i fabbisogni energetici dell’organismo per lo svolgimento dei processi biologici che hanno luogo nelle cellule vengono soddisfatti oltre che dai carboidrati anche da proteine, lipidi e alcool. L’essenzialità del glucosio quale fonte di energia deriva dal fatto che alcuni tessuti, in particolare il sistema nervoso e la midollare del surrene, in condizioni normali utilizzano il glucosio come fonte elettiva di energia, e che inoltre gli eritrociti, essendo sprovvisti dei sistemi enzimatici associati al ciclo di Krebs, sono dipendenti dalla glicolisi per il loro metabolismo energetico. La biodisponibilità di glucosio è pertanto essenziale per il corretto funzionamento di tali tessuti e riduzioni della glicemia comportano gravi conseguenze cliniche. E’ stato calcolato che per un soggetto adulto in condizioni normali sono necessari circa 180 g/die di glucosio, di qualunque origine metabolica, per soddisfare i bisogni di energia del sistema nervoso e degli eritrociti (FAO, 1980). L’uomo, come la maggior parte dei mammiferi, è capace di trasformare alcuni aminoacidi ed il glicerolo in glucosio e non ha quindi uno specifico fabbisogno alimentare per i carboidrati una volta garantito un sufficente apporto di proteine e trigliceridi. Da questo punto di vista, non si può parlare per i carboidrati di essenzialità - nel senso almeno in cui il termine viene comunemente applicato ad aminoacidi, acidi grassi, vitamine e sali minerali, nel qual caso per essenzialità si intende l’incapacità dell’organismo a sintetizzarli - ma sarebbe forse opportuno parlare di “necessarietà” . Si è infatti concordi nel sostenere che è bene che una ragionevole proporzione del fabbisogno energetico derivi dai carboidrati. Una dieta troppo ridotta in carboidrati porta infatti all’accumulo di corpi chetonici, a un eccessivo catabolismo delle proteine tessutali e alla perdita di cationi, specialmente sodio. Questi effetti possono essere prevenuti dall’ingestione di 50-100 g/die di carboidrati (Calloway, 1971). Generalmente però la quantità di carboidrati introdotti nella dieta umana è considerevolmente superiore al livello minimo di “necessarietà”. Nella dieta italiana, la quota di energia soddisfatta dai carboidrati risultava nel 1980-84 pari al 46% dell’energia, (12,5% da zuccheri) (Saba et al., 1990). La quantità ottimale di carboidrati nella dieta non è facilmente definibile, anche se l’adesione alle raccomandazioni relative ai fabbisogni in proteine e lipidi porterebbe la percentuale di energia che può derivare dai carboidrati a livelli che variano dal 55 al 65% dell’energia totale della dieta. Per questa ragione, anche in considerazione dei possibili effetti negativi collegati al crescente livello di assunzione di lipidi da parte della nostra popolazione, sarebbe opportuno raccomandare che almeno il 55% del fabbisogno energetico sia fornito dai carboidrati. Poichè parte della popolazione adulta introduce calorie dalle bevande alcoliche, una quota glucidica del 55% consente, in caso di apporto di alcol non superiore al 10% dell’energia, di introdurre le quote proteiche e lipidiche raccomandata. E’ auspicabile che questo obiettivo venga raggiunto grazie ad un aumento nel consumo di alimenti ricchi in fibra o contenenti amidi a lento assorbimento, mentre andrebbe contenuta la quota di energia derivante da zuccheri raffinati. A questo proposito va ricordato che zuccheri semplici sono contenuti in numerosi alimenti primari, tra cui latte, frutta ed alcune verdure, naturalmente ricchi anche in vitamine, minerali e/o fibra alimentare. Una dieta equilibrata e ricca in fibra basata su alimenti comuni è quindi inevitabilmente associata ad una introduzione non marginale di zuccheri semplici. In questo contesto gli zuccheri non influenzano negativamente l’indice glicemico della dieta. Gli zuccheri contribuiscono inoltre a rendere più gradevoli ed accettabili, specie in età pediatrica, diete ricche in carboidrati. Va tuttavia notato che gli zuccheri raffinati (ed in particolare il saccarosio consumato come tale o contenuto in alimenti dolci) oltre ad aumentare la densità energetica della dieta sono un fattore di rischio riconosciuto per la carie dentaria (Navia, 1994). Per questa ragione il livello di zuccheri semplici nella dieta non dovrebbe superare il 10- 12% dell’energia giornaliera, favorendo il consumo di frutta e verdure e limitando il consumo di saccarosio.
troppi errori...una diminuzione dei carboidrati porta ad una diminuzione del catabolismo proteico, proprio per l'aumento dei KB e degli FFA..


Is dietary carbohydrate essential for human
nutrition?
Dear Sir:
I read with interest the article by Dewailly et al (1) regarding
diet and cardiovascular disease in the Inuit of Nunavik, but I was
disappointed that no information regarding macronutrient intake
was presented or considered in the estimation of cardiovascular
LETTERS TO THE EDITOR 951
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risk. The traditional Inuit diet consists primarily of protein and
fat, somewhat similar to the low-carbohydrate diets promoted in
popular weight-reducing diets (2). These diets have caused concern
among nutritionists because of the metabolic changes and
health risks associated with limited carbohydrate consumption
(3). However, in exploring the risks and benefits of carbohydrate
restriction, I was surprised to find little evidence that
exogenous carbohydrate is needed for human function.
The currently established human essential nutrients are water,
energy, amino acids (histidine, isoleucine, leucine, lysine, methionine,
phenylalanine, threonine, tryptophan, and valine), essential
fatty acids (linoleic and -linolenic acids), vitamins (ascorbic
acid, vitamin A, vitamin D, vitamin E, vitamin K, thiamine,
riboflavin, niacin, vitamin B-6, pantothenic acid, folic acid, biotin,
and vitamin B-12), minerals (calcium, phosphorus, magnesium,
and iron), trace minerals (zinc, copper, manganese, iodine, selenium,
molybdenum, and chromium), electrolytes (sodium, potassium,
and chloride), and ultratrace minerals (4). (Note the absence
of specific carbohydrates from this list.)
Although one current recommended dietary carbohydrate intake
for adults is 150 g/d, it is interesting to examine how this recommendation
was determined at a recent international conference (5):
“The theoretical minimal level of carbohydrate (CHO) intake is
zero, but CHO is a universal fuel for all cells, the cheapest source
of dietary energy, and also the source of plant fiber. In addition, the
complete absence of dietary CHO entails the breakdown of fat to
supply energy [glycerol as a gluconeogenic substrate, and ketone
bodies as an alternative fuel for the central nervous system
(CNS)], resulting in symptomatic ketosis. Data in childhood are
unavailable, but ketosis in adults can be prevented by a daily CHO
intake of about 50 g. This value appears to approximate the quantity
of glucose required to satisfy minimal glucose needs of the
CNS and during starvation. The Group therefore concluded that
the theoretical minimum intake of zero should not be recommended
as a practical minimum.…about 100 g of glucose/d are
irreversibly oxidized by the brain from the age of 3–4 y onward.
However, this excludes recycled carbon, gluconeogenic carbon,
for example from glycerol, and it does not account for glucose
used by other non-CNS tissues. For example, in the adult, muscle
and other non-CNS account for an additional 20–30 g of glucose
daily. For this reason a safety margin of 50 g/d is arbitrarily added
to the value of 100 g/d and the practical minimal CHO intake set
at 150 g/d beyond the ages of 3–4 y.”
Thus, although carbohydrate could theoretically be eliminated
from the diet, the recommended intake of 150 g/d ensures an adequate
supply of glucose for the CNS. However, it appears that during
starvation (a condition in which the intakes of carbohydrate,
protein, and fat are eliminated), an adequate amount of substrate
for the CNS is provided through gluconeogenesis and ketogenesis
(6). The elimination of dietary carbohydrate did not diminish
the energy supply to the CNS under the conditions of these experiments.
Second, carbohydrate is recommended to avert symptomatic
ketosis. In the largest published series on carbohydraterestricted
diets, ketosis was not typically symptomatic (7).
The most direct way to determine whether carbohydrate is an
essential nutrient is to eliminate it from the diet in controlled laboratory
studies. In studies involving rats and chicks, the elimination
of dietary carbohydrate caused no obvious problems (8–12).
It was only when carbohydrate restriction was combined with
glycerol restriction (by substituting fatty acids for triacylglycerol)
that chicks did not develop normally (13). Thus, it appears
that some minimum amount of a gluconeogenic precursor is
essential—for example, glycerol obtained from fat (triacylglycerol)
consumption. More subtle abnormalities from carbohydrate
elimination might not have been observed in these studies. In
addition, the essentiality of some nutrients is species-specific;
therefore, these studies do not provide convincing evidence that
elimination of dietary carbohydrate is safe in humans (4).
The usual way to discover the essentiality of nutrients is
through the identification of specific deficiency syndromes (4).
I found no evidence of a carbohydrate deficiency syndrome in
humans. Protein deprivation leads to kwashiorkor, and energy
deprivation leads to marasmus; however, there is no specific
carbohydrate deficiency syndrome. Few contemporary human
cultures eat low-carbohydrate diets, but the traditional
Eskimo diet is very low (50 g/d) in carbohydrate (2). It is
possible that if more humans consumed diets severely
restricted in carbohydrate, a carbohydrate deficiency syndrome
might become apparent.
When carbohydrates are eliminated from the diet, there is a risk
that intakes of vitamins, minerals, and perhaps yet unidentified
beneficial nutrients provided by carbohydrate-rich foodstuffs (eg,
fiber) will be inadequate. There are case reports of extreme dieters
who probably developed deficiencies. One dieter who only ate
cheese, meat, and eggs (no vegetables) was reported to have developed
thiamine-deficient optic neuropathy (14). Another dieter
may have developed a relapse of acute variegate porphyria (15).
However, most of the current low-carbohydrate, weight-reducing
diets advocate the consumption of low-carbohydrate vegetables and
vitamin supplements.
Although there is certainly no evidence from which to conclude
that extreme restriction of dietary carbohydrate is harmless,
I was surprised to find that there is similarly little evidence
to conclude that extreme restriction of carbohydrate is harmful.
In fact, the consequential breakdown of fat as a result of carbohydrate
restriction may be beneficial in the treatment of obesity (7).
Perhaps it is time to carefully examine the issue of whether carbohydrate
is an essential component of human nutrition.
Eric C Westman
Department of Medicine
Duke University Medical Center
Suite 200-B Wing
Box 50, 2200 West Main Street
Durham, NC 27705
Email: ewestman@duke.edu
REFERENCES
1. Dewailly E, Blanchet C, Lemieux S, et al. n3 Fatty acids and cardiovascular
disease risk factors among the Inuit of Nunavik. Am J
Clin Nutr 2001;74:464–73.
2. Shaffer PA. Antiketogenesis. II. The ketogenic antiketogenic balance
in man. J Biol Chem 1921;47:463–73.
3. Westman EC. A review of very low carbohydrate diets for weight
loss. J Clin Outcomes Manage 1999;6:36–40.
4. Harper AE. Defining the essentiality of nutrients. In: Shils MD,
Olson JA, Shihe M, Ross AC, eds. Modern nutrition in health and
disease. 9th ed. Boston: William and Wilkins, 1999:3–10.
5. Bier DM, Brosnan JT, Flatt JP, et al. Report of the IDECG Working
Group on lower and upper limits of carbohydrate and fat intake. Eur
J Clin Nutr 1999;53(suppl):S177–8.
952 LETTERS TO THE EDITOR
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6. Cahill GF. Starvation in man. N Engl J Med 1970;282:668–75.
7. Palgi A, Read JL, Greenberg I, Hoefer MA, Bistrian BR, Blackburn
GL. Multidisciplinary treatment of obesity with a protein-sparing
modified fast: results in 668 outpatients. Am J Public Health
1985;75:1190–4.
8. Follis RH, Straight WM. The effect of a purified diet deficient in
carbohydrate on the rat. Bull Johns Hopkins Hosp 1943;72:39–41.
9. Renner R, Elcombe AM. Metabolic effects of feeding “carbohydrate-
free” diets to chicks. J Nutr 1967;93:31–6.
10. Renner R, Elcombe AM. Protein as a carbohydrate precursor in the
chick. J Nutr 1967;93:25–30.
11. Renner R. Effectiveness of various sources of nonessential nitrogen
in promoting growth of chicks fed carbohydrate-containing and
“carbohydrate-free” diets. J Nutr 1968;98:297–302.
12. Renner R. Factors affecting the utilization of “carbohydrate-free”
diets by the chick. I. Level of protein. J Nutr 1964;84:322–6.
13. Renner R, Elcombe AM. Factors affecting the utilization of “carbohydrate-
free” diets by the chick. II. Level of glycerol. J Nutr
1964;84:327–30.
14. Hoyt CS, Billson FA. Low-carbohydrate diet optic neuropathy. Med
J Aust 1977;1:65–6.
15. Quiroz-Kendall E, Wilson FA, King LE Jr. Acute variegate porphyria
following a Scarsdale Gourmet Diet. J Am Acad Dermatol
1983;8:46–9.