Carbohydrates 2

2019

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 Lecture outline
Carbohydrates
• chemistry
• function
• dietary recommendations
• digestion, absorption
• metabolism
• in health and disease

2
 Summary of digestion of dietary
CHO
Hydrolysis in the mouth

Hydrolysis in the small bowel

Absorption in the small bowel

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 Digestion and Absorption of
Carbohydrates

* The rate of starch digestion and

absorption varies depending on the type of
starch.
Mouth

•salivary glands secret salivary amylase into

mouth
•amylase breaks starch into smaller
polysaccharides and maltose 4
 Digestion and Absorption of
Carbohydrates

Stomach
• stomach acid inactivates salivary amylase
• no CHO digesting enzymes in stomach
• fiber stays in stomach longer and delays
gastric emptying, „full feeling‟ (not
digested)

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 Digestion and Absorption of
Carbohydrates cont.
Small intestine

• Pancreas produces and releases

pancreatic amylase into small intestine
through pancreatic duct, it breaks down
polysaccharides to smaller chains and
disaccharides.

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 Digestion and Absorption of
Carbohydrates cont. ; Small intestine

•Disaccharides are broken down by enzymes

that are attached to the cells of the lining of the
small intestine (brush border enzymes). These
enzymes are as follows:
•Maltase- breaks maltoseglucose + glucose
•Sucrase – breaks sucrose  fructose+glucose
•Lactase – breaks lactose galactose+glucose
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Disaccharides

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A fibre-rich diet,
A low-fibre diet,
digestion and
digestion and
absorption of
absorption occur
nutrients is slow
more rapidly.

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 Lecture outline
Carbohydrates
• chemistry
• Function
• dietary recommendations
• digestion, absorption
• Metabolism
• in health and disease

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 Metabolism of CHO

Metabolism is:
• process where the cells convert
nutrients from foods to energy that can
be used
• synthesis of new compounds for the
structure and function of cells
• sum of all the chemical reactions that
take place in a living organism

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Distribution of glucose after a meal

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http://www.medbio.info/Horn/Time%203-4/homeos1.jpg
Glucose is metabolized through
*cellular respiration.

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Overview of glucose metabolism

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Glycolysis

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Acetyl-CoA Formation

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Citric acid cycle

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Electron transport
chain 19
 Metabolism of Carbohydrates

What happens if there is not enough CHO

available in the body to get glucose for
energy???

Gluconeogenesis: Glucose / new / making

-making glucose from a non-carbohydrate
source
- Protein, in the absence of CHO, can be
converted to glucose. Fat does not readily
convert to glucose.
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 Metabolism of Carbohydrates

• “protein-sparing” refers to the action of

carbohydrates and fat to provide adequate
energy so that protein can be used for
roles that only protein can specifically do
(ie, the building of body tissues).

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 Metabolism of Carbohydrates
Ketone Bodies
• Ketone bodies are products of incomplete
breakdown of fat when glucose is not readily
available
• The muscle can use ketones for energy but
if too much = ketosis.
• Ketosis disturbs the body‟s normal acid-
base balance  health problems.
• To prevent ketosis, the body usually needs
between 50 -100 grams of CHO per day.
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CHO is in short supply, oxaloacetate will
be limited. Acetyl-CoA from fatty acid
breakdown will therefore not be able to
enter the citric acid cycle. Instead, the
liver uses it to make ketone bodies.
CHO available. Acetyl-CoA can
combine with oxaloacetate to
form glucose as shown above.
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 Lecture outline
Carbohydrates
• chemistry
• Function
• dietary recommendations
• digestion, absorption
• Metabolism
• in health and disease

24
 Problems with CHO Digestion
Lactose intolerance

• Lactase enzyme < active,

• Lactase activity decreases dramatically after infanthood and

may be genetic,

• resulting in an inability to digest lactose

• so lactose is not hydrolysed as normal but released into

colon and fermented by bacteria  nausea, pain, bloating,
diarrhea, excessive gas

• Dietary modifications for lactose intolerance?

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 Problems with Carbohydrate Digestion
Galactosemia

• A condition where galactose-1-phosphate uridyl

transferase is not functional or not present.
Galactose cannot be converted to glucose so it
accumulates in cells.
• If accumulation of galactose level in blood and
urine increases,
 brain damage, damage to central nervous
system, liver and eyes (eye cataract because of
conversion of galactose to galactitol)
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 Regulation of Blood Glucose

Glucose Homeostasis - the body needs to maintain blood

glucose between 80-120 mg/dl

Blood glucose levels are regulated by 3 following hormones:

Insulin - secreted by pancreas (β cells) in response to
increased glucose in the blood. Transports glucose from the
blood to the cells.

Glucagon - secreted by pancreas (α cells) in response to low

blood glucose which stimulates the liver to break down
glycogen and release glucose in the blood  body tissues

Epinepherine /adrenaline – released from the adrenal

glands in response to stress, also stimulates liver to break
down glycogen and release glucose in the blood  body 27
tissues
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 A. AFTER a meal
blood glucose
stimulated by Insulin
Glycogen Glucose-6-Phosphate Glucose

for synthesis of fatty acids used as fuel for energy

transported as very low density lipoprotein (VLDL)  to adipose tissue

Blood glucose regulation by the liver AFTER a meal

(when blood glucose is high)
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B. BEFORE/BETWEEN MEALS

Glucose is released into the blood and goes to other body cells

stimulated by Glucagon
Glycogen Glucose-6-Phosphate Glucose

fatty acids used by liver as fuel for energy

fatty acids from adipose tissue

Blood glucose regulation by the liver BEFORE a

meal (when blood glucose is low) 30
A fibre-rich diet,
A low-fibre diet,
digestion and
digestion and
absorption of
absorption occur
nutrients is slow
more rapidly.

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32
 Health Effects of
Unregulated Blood Glucose

Diabetes: carbohydrate metabolism disorder

resulting from inadequate or ineffective insulin

Hypoglycemia: abnormally low blood

glucose concentration

Glycosuria/glucosuria: glucose in the urine,

which generally occurs when blood glucose
exceeds 180mg/100ml
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 DIABETES
Type 1 Type 2
Less Common More Common
Juvenile onset: usually Adult onset
IDDM: Insulin Dependent NIDDM: Non-insulin
Diabetes Mellitus Dependent Diabetes Mellitus
Pancreas fails to produce
Cells fail to respond to insulin
insulin
Factors influencing onset:
Factors influencing onset:
genetics, obesity especially
genetics, toxins, virus,
central adiposity, poor diet
disordered immune system
Control: dietary control and
Control: exogenous supply of
physical activity, lastly but not
insulin by injection
necessarily medication
(consult a medical doctor 34
 Glycaemic CHO- factors that
affect it
• Other factors that are intrinsic to the foods and consumer
habits
• Food:
– Particle size
– Macrostructure and microstructure of food, especially whether
cell walls are intact
– amylose:amylopectin ratio of starches
– Lipid content of food
– Presence (or absence) of enzyme inhibitors
• Consumer factors:
– Degree of comminution in the mouth
– Rate of gastric emptying
– Small bowel transit time.
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 36
Introduced by Jenkins et al., 1998
 CHO and GI, GL and health
• CHO-containing foods such as wholegrains, legumes,
vegetables and whole fruits reduce the risk of diabetes
and CVD (Mann et al., 2007).
• longitudinal observational study (n=5000 Danish
subjects over 12 years) Jakobsen et al., (2010)
– Substituting saturated fat with CHO will reduce CVD risk only if these
CHO have low GI.
– high GI CHO increase the risk of myocardial infarction.
– Diet higher in GI or GLis associated with higher risk of type-2 diabetes
mellitus.
• no evidence from prospective cohort studies on
association between GI and CVD or CHD.
• there is association between GI with greater risk of CVD
but only reported in a small number of studies (SACN,
2015). 37
Potential Health Effects of Fiber and Starch

Weight control: lower in fat, provides satiety

and bulk
Heart Disease: lowers blood cholesterol
(binds bile acids), lowers heart disease risk
Cancer: Populations who consume high-fiber
have lower rates of colon cancer, binds
cancer-causing agents in colon, lowers colon
pH through fermentation
GI Health: Helps prevent diverticulitis:
infection from weakening of intestinal walls 38
 Potential detriments of too much fiber

• Speeds GI transit and limits adequate

absorption of nutrients
• in populations who need more energy
(children & undernourished adults), binds
minerals (which interferes with absorption
 deficiency )

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 Potential Health Effects of Fiber
Type of Fibre Major food Possible health effects
source
Soluble Barley, fruits, -lowers blood choles.
Gums, legumes, oats, -slow glucose absorpt.
mucilages, oat bran, -slow transit of foods
pectins, some seeds, vege through upper GI;holds
hemicellulose moisture in stool
Insoluble Brown rice, -Soften stools, bowel
Cellulose, lignin, fruits, movement regular,
some legumes, speeds transit of
hemicellulose vegetables, material through GI
wheat bran, -< risk of diverticulosis,
whole grains hemorrhoids,
appendicitis, colon
cancer 40
 Free sugars –the concern
• may promote a positive energy balance.
• ie. sugar-sweetened beverages increases
overall energy intake, may reduce the intake of
more nutrient dense foods  unhealthy diet,
weight gain and increased risk of NCDs (Hauner
et al., 2012, Malik et al.,2013).
• intake of free sugars and dental caries (Sheiham
& James, 2014).

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