Experimental and Clinical Investigations of Slowly Digestible Carbohydrates for Improved Physiological Outcomes and Metabolic Health

The world has experienced an unprecedented change in the systems responsible for food production, distribution, and commercialization with concurrent changes in diets. In developed and developing countries, the shift in consumption patterns has moved towards a Western diet pattern which has been linked to negative health outcomes including obesity, diabetes and associated non-communicable diseases. Traditional African diets have previously been associated with protective effects against the development of the above-mentioned conditions. Yet, the underlying reasons for this is not clear. One dietary factor that may contribute to its protective effect is the principal available carbohydrate, starch, which in traditional African staples is considered to contain slowly digestible carbohydrates (SDCs) and some amount of resistant starch (RS). We reported that traditional African staple starchy foods (sorghum and millet) had markedly slower gastric emptying than introduced modern starchy foods (rice, pasta and potatoes). This response was attributed to activation of enteroendocrine cells of the small intestine (L-cells) with potential to trigger physiological, hormonal, and neurological processes that affect digestion time and perception of hunger; effect known as the ileal brake. Moreover, at least in mice models, consumption of SDCs has shown to have beneficial effects on the rate and type of fuel (e.g. carbohydrate vs fat) used for metabolic processes. The first thesis study compared the effect of diets (cohorts in the USA and Kenya) on gastric half-emptying time and metabolic fuel utilization in healthy adults. Our findings showed that gastric emptying time was not different between cohorts and that diet did not influence gastric emptying time; however, calculated respiratory exchange ratio (RER) (which is a measure of metabolic fuel utilization at the cellular level, e.g. carbohydrate vs fat) and metabolic flexibility (which is the ability to switch between metabolic fuel sources upon demand or need) was higher for the Kenyan cohort. Multivariant models were developed and corrected for multicollinearity of some diet variables. Carbohydrate and protein in multivariate model 1; total fiber, added sugars and starch in multivariate model 2; and diet quality (measured as the Healthy Eating Index based on 2015-2020 dietary guidelines, or HEI-2015) in multivariate model 3, were significantly and independently correlated with RER and metabolic flexibility. The second study assessed if slow gastric emptying and improve metabolic fuel utilization could be induced through SDC supplementation. The objective of this study was to determine if continual consumption of SDC for 21 days delayed the rate of gastric emptying, moderated postprandial glycemic response, decreased hunger, and/or improved metabolic fuel utilization in subjects with low diet quality (HEI-2015\u3c65). Our results indicated that supplementation with SDC did not slow gastric emptying time or acute measures of metabolic fuel utilization; however, continuous consumption of SDC had a modest but significant effect on improving metabolic flexibility and decreasing hunger scores. The last two chapters of this thesis focused on the use of a low-cost, high-pressure, high temperature extruder suitable for processing in Africa of whole grain pearl millet (Pennisetum glaucum). In Africa, emerging, entrepreneurial companies are increasingly gaining share of local markets by manufacturing and distributing high-quality locally sourced processed foods made with indigenous grains. Whole pearl millet is particularly susceptible to development of rancidity