General Principles of Digestion and Metabolism

The Process of Digestion

1. Digestion - large food molecules are broken down to
smaller molecules, both mechanically and
chemically
a. Mechanical digestion involves the physical
breakdown of food but does not alter its
chemical makeup.
b. Chemical digestion is a complex process that
reduces food into its chemical building
blocks, which are then absorbed to nourish
the cells of the body.
2. Absorption - process of transporting these smaller
molecules across the intestinal wall
3. Elimination - undigested portions of food and waste
products are removed from the body
Figure 1. Digestion and Absorption. Digestion
begins in the mouth and continues as food travels
through the small intestine. Most absorption occurs
in the small intestine.
Chemical Digestion
Large food molecules (for example, proteins, lipids, and starches) must be broken down into
subunits that are small enough to be absorbed by the lining of the alimentary canal. This is
accomplished by enzymes through hydrolysis. The many enzymes involved in chemical digestion are
summarized below.

Enzymes from the salivary glands (salivary amylase) attack carbohydrates (and fats in some
species); enzymes from the stomach (pepsin and gastric lipase) attack proteins and fats; and enzymes
from the exocrine portion of the pancreas (pancreatic amylase, protease and pancreatic lipase) attack
carbohydrates, proteins, lipids, DNA, and RNA.

Other enzymes that complete the digestive process are found in the luminal membranes and the
cytoplasm of the cells that line the small intestine. The action of the enzymes is aided by the
hydrochloric acid secreted by the stomach and the bile secreted by the liver.

Carbohydrate Digestion

Three monosaccharides commonly consumed and readily absorbed: glucose, galactose, and
fructose. Disaccharide sucrose, lactose, and maltose and the polysaccharides glycogen and starch
(chains of monosaccharides) are also broken down by the
body. Your bodies do not produce enzymes that can break
down most fibrous polysaccharides, such as cellulose.
While indigestible polysaccharides do not provide any
nutritional value, they do provide dietary fiber, which
helps propel food through the alimentary canal.

The chemical digestion of starches begins in the

mouth. In the small intestine, pancreatic amylase does the
‘heavy lifting’ for starch and carbohydrate digestion.
After amylases break down starch into smaller fragments,
the brush border enzyme α-dextrinase starts working on
α-dextrin (breakdown product of starch), breaking off one
glucose unit at a time. Three brush border enzymes
hydrolyze sucrose, lactose, and maltose into
monosaccharides.

Figure 2. Carbohydrate Digestion Flow Chart. Carbohydrates are broken down into their monomers
in a series of steps
Protein Digestion

Proteins are polymers composed of amino acids linked by peptide bonds to form long chains.
Digestion reduces them to their constituent amino acids. You usually consume about 15 to 20 percent
of your total calorie intake as protein.

The digestion of protein starts in the stomach, where HCl and pepsin break proteins into smaller
polypeptides, which then travel to the small intestine (Figure 3). Chemical digestion in the small
intestine is continued by pancreatic enzymes, including chymotrypsin and trypsin, each of which act
on specific bonds in amino acid sequences. At the same time, the cells of the brush border secrete
enzymes such as aminopeptidase and dipeptidase, which further break down peptide chains. This
results in molecules small enough to enter the bloodstream.

Figure 3. Digestion of Protein. The digestion of protein begins in the stomach and is completed in the
small intestine.

Lipid Digestion

A healthy diet limits lipid intake to 35 percent of total calorie intake. The most common
dietary lipids are triglycerides, which are made up of a glycerol molecule bound to three fatty acid
chains. Small amounts of dietary cholesterol and phospholipids are also consumed.

The three lipases responsible for lipid digestion are lingual lipase, gastric lipase, and  pancreatic
lipase. However, because the pancreas is the only consequential source of lipase, virtually all lipid
digestion occurs in the small intestine. Pancreatic lipase breaks down each triglyceride into two free
fatty acids and a monoglyceride. The fatty acids include both short-chain (less than 10 to 12 carbons)
and long-chain fatty acids.

Nucleic Acid Digestion

The nucleic acids DNA and RNA are found in most of the foods you eat. Two types of pancreatic
nuclease are responsible for their digestion: deoxyribonuclease, which digests DNA,
and ribonuclease, which digests RNA. The nucleotides produced by this digestion are further broken
down by two intestinal brush border enzymes (nucleosidase and phosphatase) into pentoses,
phosphates, and nitrogenous bases, which can be absorbed through the alimentary canal wall. The
large food molecules that must be broken down into subunits are summarized 

Absorbable Food Substances (Table 9)

Source & Substance

 Carbohydrate Monosaccharides: glucose, galactose, and fructose
s
Proteins Single amino acids, dipeptides, and tripeptides
Triglycerides Monoacylglycerides, glycerol, and free fatty acids
Nucleic acids Pentose sugars, phosphates, and nitrogenous bases

Absorption

The mechanical and digestive processes have one goal: to convert food into molecules small
enough to be absorbed by the epithelial cells of the intestinal villi.

Almost all ingested food, 80 percent of electrolytes, and 90 percent of water are absorbed in
the small intestine. Although the entire small intestine is involved in the absorption of water and
lipids, most absorption of carbohydrates and proteins occurs in the jejunum. Notably, bile salts and
vitamin B12 are absorbed in the terminal ileum. By the time chyme passes from the ileum into the
large intestine, it is essentially indigestible food residue (mainly plant fibers like cellulose), some
water, and millions of bacteria

Absorption is achieved by the following mechanisms.

1. Active transport
- may be defined as the process of solute movement from the lower concentration to the higher
concentration by the expense of energy.
Electrolytes like Na ions are absorbed by active transport into the blood.
2. Facilitated transport.
- is defined as the process of movement of solutes across the biological membrane with the
help of specific carrier proteins. Some digested amino acids and glucose are absorbed into the
blood by this method.
3. Passive transport.
- is defined as the process of solute movement across a cell membrane without a requirement
of energy. After digestion, simpler food substance is absorbed into the blood by passive
transport.
Some digested products from fats cannot be absorbed into the blood. Example: Fatty acids and
glycerol. These components attach to micelles which are small droplets and form the micelle-
component complex. This micelle – component complexes are re-formed into chylomicrons.
Chylomicrons are a small protein coated fat globules. Then, chylomicrons move into the lymph
vessels and release the digested products into the blood. Finally, the digested and absorbed products
reach the tissue to be utilized for their activities. This process is called as assimilation.

Carbohydrate Absorption

All carbohydrates are absorbed in the form of monosaccharides. The small intestine is highly
efficient at this, absorbing at an estimated rate of 120 grams per hour.

Process: After Carbohydrate digestion, it will be broken down into its building blocks which is the
Glucose molecules. Within the Lumen of small intestine there are many Sodium Ions, it plays an
important role in absorption of glucose into the body. In the Enterocyte (Intestinal cells) there is a
Sodium Glucose Linked Transport (SGLT) which function as co-transport of 2 sodium and 1
glucose. Once they are inside the cell, they are reabsorb by the bloodstream through Glut 2
transport. It will increase blood glucose levels and glucose can be used as energy.

Protein Absorption

Almost all (95 to 98 percent) protein is digested and absorbed in the small intestine.

The small polypeptides (Breakdown product of protein) will be digested further into small
polypeptide, dipeptides and amino acid. The body can now begin into Absorption. The Tripeptide (an
example of Small Polypeptide) can be absorb in the enterocyte by Co-transport with Hydrogen.
Once it is inside the cell, it can be hydrolyze by Cellular peptidases and broken down into Amino
acid. Then the Amino acid can now diffuse into the bloodstream and will be carried to the liver.

Lipid Absorption

Absorption of fats occurs only in the

small intestines. Once the triglycerides are
broken down into individual fatty acids and
glycerols, along with cholesterol, they will
aggregate into structures called micelles. Fatty
acids and monoglycerides leave the micelles and
diffuse across the membrane to enter the
intestinal epithelial cells. In the cytosol of
epithelial cells, fatty acids and monoglycerides
are recombined back into triglycerides. In the
cytosol of epithelial cells, triglycerides and
cholesterol are packaged into bigger particles
called chylomicrons which are amphipathic
structures that transport digested lipids.
Chylomicrons will travel through the
bloodstream to enter adipose and other tissues in
the body

Fig 6. Lipid Absorption. Unlike amino acids and simple sugars, lipids are transformed as they are
absorbed through epithelial cells.

Nucleic Acid Absorption

The products of nucleic acid digestion—pentose sugars, nitrogenous bases, and phosphate
ions—are transported by carriers across the villus epithelium via active transport. These products
then enter the bloodstream.

Mineral Absorption

The electrolytes absorbed by the small intestine are from both GI secretions and ingested
foods. Since electrolytes dissociate into ions in water, most are absorbed via active transport
throughout the entire small intestine. During absorption, co-transport mechanisms result in the
accumulation of sodium ions inside the cells, whereas anti-port mechanisms reduce the potassium ion
concentration inside the cells. To restore the sodium-potassium gradient across the cell membrane, a
sodium-potassium pump requiring ATP pumps sodium out and potassium in.

In general, all minerals that enter the intestine are absorbed, whether you need them or not.
Iron and calcium are exceptions; they are absorbed in the duodenum in amounts that meet the body’s
current requirements.

Vitamin Absorption

The small intestine absorbs the vitamins that occur naturally in food and supplements. Fat-
soluble vitamins (A, D, E, and K) are absorbed along with dietary lipids in micelles via simple
diffusion. Most water-soluble vitamins (including most B vitamins and vitamin C) also are absorbed
by simple diffusion. An exception is vitamin B 12, which is a very large molecule. Intrinsic factor
secreted in the stomach binds to vitamin B 12, preventing its digestion and creating a complex that
binds to mucosal receptors in the terminal ileum, where it is taken up by endocytosis.

Water Absorption

Each day, about nine liters of fluid enter the small intestine. About 2.3 liters are ingested in
foods and beverages, and the rest is from GI secretions. About 90 percent of this water is absorbed in
the small intestine. Water absorption is driven by the concentration gradient of the water: The
concentration of water is higher in chyme than it is in epithelial cells. Thus, water moves down its
concentration gradient from the chyme into cells. As noted earlier, much of the remaining water is
then absorbed in the colon.

Metabolism

Once the food has been digested and absorbed, the various nutrients are distributed to the
tissues via the blood and, having passed through the cell membranes, are exposed to the metabolic
machinery of the cell. The purpose of this machinery is (1) to release some of the energy contained in
the nutrients and convert it into a form that can be used for the various functions of the cell, and (2)
to use the rest of the material for the synthesis of substances that the body needs for its growth and
activities.

In order to do this the food materials are subjected to a variety of metabolic processes, each
of which involves a well-defined sequence of reactions. Nearly every step is catalysed by a different
enzyme, and results in a small but specific chemical change. This field of intermediary metabolism
constitutes a major part of biochemistry. The main metabolic pathways have by now all been
elucidated, and metabolic maps prepared, which show the possible origins and fates of all the major
cellular constituents.

Broadly speaking, metabolism may be divided into three areas. (1) Catabolism. This deals with the
breakdown of materials with the release of energy. In the process, carbon dioxide and water are
produced, but these are essentially by-products since it is the energy liberated during their formation
that the body requires, and rarely the carbon dioxide and water themselves. (2) Anabolism covers the
processes by which complex substances are built up from simple precursors, and this utilizes much of
the energy released during the course of catabolism. (3) Between the clearly defined anabolic and
catabolic pathways lies a central area of metabolism in which various simple compounds are
interconverted.

The pathways are said to be amphibolic since they have a dual function (amphi = both) and
provide material which may be used either for synthesis or for breakdown. Amphibolic pathway, a
biochemical pathway that serves both anabolic and catabolic processes. An important example of an
amphibolic pathway is the Krebs cycle which is also called Citric acid cycle, which involves both the
catabolism of carbohydrates and fatty acids and the synthesis of anabolic precursors for amino-acid
synthesis. All the metabolic pathways involve the uptake or release of energy.Energy is required for:

1. Chemical syntheses and the process of growth in which complex, highly organized molecules are
built and assembled from small molecular precursors.

2. The maintenance of the highly ordered structure of the cell.

3. Transport and the movement of materials against a concentration gradient, i.e. from a region of
lower to one of higher concentration.

4. Mechanical work, e.g. the contraction of muscles and movement of cilia.

Without the expenditure of energy, membranes and other cell structures would disintegrate and it is
only by the constant expenditure of energy that living organisms are able to adapt continually to the
prevailing conditions.

Case Study

Gastroparesis

Gastroparesis is a condition in which

your stomach cannot empty itself of food in
a normal fashion. It can be caused by
damage to the vagus nerve, which regulates
the digestive system. A damaged vagus
nerve prevents the muscles in the stomach
and intestine from functioning, preventing
food from moving through the digestive system properly. Often, the cause of gastroparesis is
unknown.

Causes of gastroparesis

 Uncontrolled diabetes
 Gastric surgery with injury to the vagus nerve
 Medications such as narcotics and some antidepressants
 Parkinson's disease
 Multiple sclerosis
 Rare conditions such as: amyloidosis (deposits of protein fibers in tissues and organs) and
scleroderma (a connective tissue disorder that affects the skin, blood vessels, skeletal
muscles, and internal organs)

There are many symptoms of gastroparesis, including:

 Heartburn or GERD
 Nausea
 Vomiting undigested food
 Feeling full quickly when eating
 Abdominal bloating
 Poor appetite and weight loss
 Poor blood sugar control

Treatment

Gastroparesis is a chronic (long-lasting) condition. This means that treatment usually doesn't
cure the disease. But there are steps you can take to manage and control the condition.

Some patients may benefit from medications, including:

 Reglan (metoclopramide): You take this drug 30 mins before eating and it causes the stomach
muscles to contract and move food along. Reglan also decreases the incidence of vomiting
and nausea. Side effects include diarrhea, drowsiness, anxiety, and, rarely, a serious
neurological disorder. Not allowed for children and when taking, it should not exceed from 2-
4 or 8-12 weeks.
 Erythromycin: This is an antibiotic that also causes stomach contractions and helps move
food out. Side effects include diarrhea and development of resistant bacteria from prolonged
exposure to the antibiotic.
 Antiemetics: These are drugs that help control nausea.

People who have diabetes should try to control their blood sugar levels to minimize the problems of
gastroparesis.

In a severe case of gastroparesis, a feeding tube, or jejunostomy tube (G-J gastro-jejunal tube), may
be used. The tube is inserted through the small intestine during surgery. To feed yourself, put
nutrients into the tube, which go directly into the small intestine; this way, they bypass the stomach
and get into the bloodstream more quickly.