05/07/2020 Physiology, Carbohydrates - StatPearls - NCBI Bookshelf

NCBI Book sh elf. A ser v ice of t h e Na t ion a l Libr a r y of Medicin e, Na t ion a l In st it u t es of Hea lt h .

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-.

Physiology, Carbohydrates
Authors

Julie E. Holesh; Sanah Aslam1; Andrew Martin2.

Affiliations
1 Augusta University Health
2 Campbell University

Last Update: April 24, 2020.

Introduction
Carbohydrates are one of the three macronutrients in the human diet, along with protein and fat. These molecules contain
carbon, hydrogen, and oxygen atoms. Carbohydrates play an important role in the human body. They act as an energy source,
help control blood glucose and insulin metabolism, participate in cholesterol and triglyceride metabolism, and help with
fermentation. The digestive tract begins to break down carbohydrates into glucose, which is used for energy, upon
consumption. Any extra glucose in the bloodstream is stored in the liver and muscle tissue until further energy is needed.
Carbohydrates is an umbrella term that encompasses sugar, fruits, vegetables, fibers, and legumes. While there are numerous
divisions of carbohydrates, the human diet benefits mostly from a certain subset.[1][2][3]

Structures

Monosaccharide: The most basic, fundamental unit of a carbohydrate. These are simple sugars with the general chemical
structure of C6H12O6.

Examples: glucose, galactose, fructose

Disaccharide: Compound sugars containing two monosaccharides with the elimination of a water molecule with the general
chemical structure C12H22O11

Examples: sucrose, lactose

Oligosaccharide: The polymer contains three to ten monosaccharides

Examples: maltodextrins, raffinose

Polysaccharides: Polymers containing long chains of monosaccharides connected through glycosidic bonds

Examples: amylose, cellulose

Types

Simple Carbohydrates: One or two sugars (monosaccharides or disaccharides) combined in a simple chemical structure.
These easily are utilized for energy, causing a rapid rise in blood sugar and insulin secretion from the pancreas.

Examples: fructose, lactose, maltose, sucrose, glucose, galactose, ribose

Foods: candy, carbonated beverages, corn syrup, fruit juice, honey, table sugar

Complex Carbohydrates: Three or more sugars (oligosaccharides or polysaccharides) bonded together in a more complex
chemical structure. These take longer to digest and therefore have a more gradual effect on the increase in blood sugar.

Examples: cellobiose, rutinulose, amylose, cellulose, dextrin

Foods: apples, broccoli, lentils, spinach, unrefined whole grains, brown rice

Starches: Complex carbohydrates contain a large number of glucose molecules. Plants produce these polysaccharides.

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Examples include potatoes, chickpeas, pasta, and wheat.

Fiber: Non-digestible complex carbohydrates that encourage healthy bacterial growth in the colon and act as a bulking agent,
easing defecation. The main components include cellulose, hemicellulose, and pectin.

Insoluble: Absorbs water in the intestines, thereby softening and bulking stool. Benefits include regularity of bowel
movements and a decreased risk of diverticulosis.

Examples: brans, seeds, vegetables, brown rice, potato skins.

Soluble: Helps decrease blood cholesterol and LDL levels, reduces straining with defecation, and blunts postprandial
blood glucose levels.

Examples are fleshy fruit, oats, broccoli, and dried beans.

Issues of Concern
Carbohydrates are associated with dental caries. Eating large amounts of sugary foods is known to lead to plaque formation,
tooth decay, and cavities. The worst carbohydrate for dental decay is sucrose. On the other hand, fructose serves as an
energy source for oral cavity bacteria.[4][5][6]

Many people falsely believe that that diets high in carbohydrates lead to the development of type 2 diabetes when, in fact, the
opposite is true. Data show that the risk of developing type 2 diabetes is lowered as the amount of calories from
carbohydrates is increased. Diets that are high in carbohydrates tend to increase the sensitivity of insulin. Thus, today,
healthcare providers usually recommend that type 2 diabetics eat a high carbohydrate diet. An additional benefit of a high
carbohydrate diet for type 2 diabetics is that it lowers the risk of heart disease.

Individuals who eat high fiber diets also tend to have low serum cholesterol and high HDL levels than people who consume a
low fiber diet; the lowering of cholesterol also decreases the risk of heart disease.

In many parts of Africa, people who eat high fiber diets tend to have a very low risk of intestinal cancer. But the exact amount
of fiber to eat to prevent colon cancer remains unknown.

Anecdotal reports maintain that eating fiber may lower blood pressure, lower the incidence of gallstones, and decrease blood
sugars.

Cellular
Metabolism

Carbohydrate digestion begins in the mouth where salivary amylase starts the breakdown. After breaking down throughout the
digestive system, monosaccharides are absorbed into the bloodstream. As carbohydrates are consumed, the blood sugar
levels increase, stimulating the pancreas to secrete insulin. Insulin signals the body’s cells to absorb the glucose for energy or
storage. If blood glucose falls, the pancreas makes glucagon, stimulating the liver to release stored glucose.

The body is not able to digest fiber, and therefore fiber does not provide calories or energy. It has a variety of health benefits
including bulking stool for easier excretion preventing constipation, prebiotic properties, satiety, and intestinal issues.

Function
Nutrition

Carbohydrates are an important part of a nutritional diet. The healthiest sources include complex carbohydrates because of
their blunted effects on blood glucose. These options include unprocessed whole grains, vegetables, fruits, and legumes. While
simple carbohydrates are acceptable in small amounts, white bread, sodas, pastries, and other highly processed foods are less
nutritious and cause a sharp increase in blood glucose. Healthy adult diets should include 45% to 65% carbohydrates as part
of the daily intake, equaling about 200 g to 300 g per day. Carbohydrates contain about 4 kcal/ gram (17 kJ/g). Fiber is an
important carbohydrate as well. Healthy adults should consume about 30 g per day of fiber, as it is found to reduce the risk of
coronary heart disease, strokes, and digestive issues.

A glycemic index is a tool used to track carbohydrates and their individual effects on blood sugar. This scale ranks
carbohydrates from 0 to 100 based on how rapidly a rise in blood glucose occurs upon consumption. Low glycemic foods
(55 or less) produce a gradual increase in blood sugar. These foods include steel cut oatmeal, oat bran, muesli, sweet
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05/07/2020 Physiology, Carbohydrates - StatPearls - NCBI Bookshelf

potatoes, peas, legumes, most fruits, non-starchy vegetables. Medium glycemic foods (56 to 69) include quick oats, brown
rice, and whole wheat bread. High glycemic foods (70 to 100) increase the risk of type 2 diabetes, heart disease, obesity, and
ovulatory infertility. These foods include white bread, corn flakes, white potatoes, pretzels, rice cakes, and popcorn.[7]

Clinical Significance
Two things that constantly affect the body include physical activity and diet. A diet needs to be nutritionally balanced, including
the proper type and amount of carbohydrates. An increase or decrease in carbohydrates beyond the desired amount can
affect both physiological and metabolic processes. An increase in simple carbohydrates may contribute to obesity, a disease
that puts individuals at an even greater risk for further disorders such as cardiovascular disease. Carbohydrate intake also
contributes to non-insulin dependent diabetes (type 2 diabetes), a growing epidemic. However, foods rich in non-starch
polysaccharides and low-glycemic foods protect against diabetes. Increased sugar consumption also contributes to the
development of dental caries.[8][9]

Questions
To access free multiple choice questions on this topic, click here.

References
1. Shah R, Alhawaj AF. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 20, 2019. Physiology, Breast
Milk. [PubMed: 30969612]
2. Bolla AM, Caretto A, Laurenzi A, Scavini M, Piemonti L. Low-Carb and Ketogenic Diets in Type 1 and Type 2
Diabetes. Nutrients. 2019 Apr 26;11(5) [PMC free article: PMC6566854] [PubMed: 31035514]
3. Mills S, Stanton C, Lane JA, Smith GJ, Ross RP. Precision Nutrition and the Microbiome, Part I: Current State of the
Science. Nutrients. 2019 Apr 24;11(4) [PMC free article: PMC6520976] [PubMed: 31022973]
4. Hevey R. Strategies for the Development of Glycomimetic Drug Candidates. Pharmaceuticals (Basel). 2019 Apr 11;12(2)
[PMC free article: PMC6631974] [PubMed: 30978966]
5. Uhrig ML, Lantaño B, Postigo A. Synthetic strategies for fluorination of carbohydrates. Org. Biomol. Chem. 2019 May
29;17(21):5173-5189. [PubMed: 31017598]
6. Kwok CS, Gulati M, Michos ED, Potts J, Wu P, Watson L, Loke YK, Mallen C, Mamas MA. Dietary components and
risk of cardiovascular disease and all-cause mortality: a review of evidence from meta-analyses. Eur J Prev Cardiol. 2019
Sep;26(13):1415-1429. [PubMed: 30971126]
7. Maino Vieytes CA, Taha HM, Burton-Obanla AA, Douglas KG, Arthur AE. Carbohydrate Nutrition and the Risk of
Cancer. Curr Nutr Rep. 2019 Sep;8(3):230-239. [PMC free article: PMC6660575] [PubMed: 30895469]
8. Mantantzis K, Schlaghecken F, Sünram-Lea SI, Maylor EA. Sugar rush or sugar crash? A meta-analysis of carbohydrate
effects on mood. Neurosci Biobehav Rev. 2019 Jun;101:45-67. [PubMed: 30951762]
9. Walsh T, Worthington HV, Glenny AM, Marinho VC, Jeroncic A. Fluoride toothpastes of different concentrations for
preventing dental caries. Cochrane Database Syst Rev. 2019 Mar 04;3:CD007868. [PMC free article: PMC6398117]
[PubMed: 30829399]

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