Central Luzon Doctors’ Hospital Educational Institution

Romulo Highway, San Pablo, Tarlac City

A.Y. 2019-2020

GENERAL PRINCIPLE OF DIGESTION AND METABOLISM OF

CARBOHYDRATES

Group 4

Acosta, Faith Ruhama V.

Balmores, Kimberly Jhoy

Gaspar, Tricia Mae A.

Gumiran, Angela Mae C.

Mapang, Maria Renalyn M.

Pineda, Tracy M.

Sardanas, Marian

Sicats, Trisha Lynne S.

Viray, Trisha Mae A.

I. OBJECTIVES

The objective of the digestion and metabolism of carbohydrates is to discuss how

carbohydrates are digested and absorbed in the human body and explain the different
pathways involving carbohydrate metabolism.

II. BODY

Carbohydrates are organic molecules composed of carbon, hydrogen, and oxygen

atoms. The family of carbohydrates includes both simple and complex sugars.

Digestion is how your body turns food you eat into nutrients it uses for energy, growth,
and cell repair.

Metabolism is a term that is used to describe all chemical reactions involved in

maintaining the living state of the cells and the organism. 

DIGESTION OF CARBOHYDRATES
From the Mouth to the Stomach

The mechanical and chemical digestion of carbohydrates begins in the mouth known as
chewing (also known as mastication), crumbles the carbohydrate foods into smaller
pieces. Saliva contains the enzyme, a-salivary amylase, this enzyme catalyzes the
hydrolysis of a-glycosidic linkages in starch from plants and glycogen from meats to
produce smaller polysaccharides and the disaccharide maltose.

Only small amount of carbohydrate digestion occurs in the mouth because food is
swallowed so quickly. Although the food remains longer in the stomach, very little
further carbohydrate digestion occurs there either, because a-salivary amylase is
inactivated by the acidic environment of the stomach, and the stomach’s own secretions
do not contain any carbohydrate-digesting enzymes. But the mechanical breakdown is
ongoing, the contractions of the stomach mix the carbohydrates into the more uniform
mixture of chyme.

From Stomach to Intestines

The primary site for carbohydrate digestion is within the small intestines, wherein upon
entry of the chyme in the upper small intestines, the a-amylase, this time is secreted by
the pancreas, again begins to function. The pancreatic a-amylase breaks down
polysaccharide chains into shorter segments until the disaccharide maltose and glucose
itself are the dominant species.

The final step in carbohydrate digestion occurs on the outer membranes of intestinal
mucosal cells, where the enzymes that convert disaccharides to monosaccharides are
located. The important disaccharide enzymes are:

1. Maltase - converts maltose into two glucose units

2. Sucrase - converts sucrose to one glucose and one fructose unit
3. Lactase - converts lactose to one glucose and one galactose unit
Absorption: To the Bloodstream
The three major breakdown products from carbohydrate from carbohydrate digestion
are glucose, galactose and fructose. These monosaccharides are absorbed into the
bloodstream through intestinal wall. The folds of the of the intestinal wall are lined with
fingerlike projections called villi. Absorption is by active transport. In this case ATP is
needed. Protein carrier mediate the passage of monosaccharides through cell
membranes. After their absorption into the bloodstream, monosaccharides are
transported to the liver.
Maintaining Blood Glucose Levels: The Pancreas and Liver

Glucose levels in the blood are tightly controlled, as having either too much or too little
glucose in the blood can have health consequences. Glucose regulates its levels in the
blood via a process called negative feedback.

Insulin-secreting cells (pancreatic beta cells) in the pancreas sense the increase in
blood glucose and release the hormonal message, insulin, into the blood. Insulin sends
a signal to the body’s cells to remove glucose from the blood by transporting it into cells
and within the cell to use glucose to make energy. Insulin has an opposing hormone
called glucagon. Glucagon-secreting cells in the pancreas (pancreatic alpha-cells)
sense the drop in blood glucose and, in response, release the hormone glucagon into
the blood. Glucagon communicates to the cells in the body to stop using glucose. More
specifically, it signals the liver to break down glycogen and release the stored glucose
into the blood, so blood glucose levels stay within the target range and all cells get the
fuel the need to function properly.

Epinephrine or adrenaline is released in response to stress or exercise. It causes the

breakdown of glycogen, or glycogenolysis, which releases glucose and increases blood
glucose levels.

METABOLISM OF CARBOHYDRATES

Carbohydrate metabolism begins with digestion in the small intestine where

monosaccharides are absorbed into the blood stream. Blood sugar concentrations are
controlled by three hormones: insulin, glucagon, and epinephrine.

In the liver and muscles, most of the glucose is changed into glycogen by the process
of glycogenesis (anabolism). 

Anabolism occurs when smaller molecules such as monosaccharides, amino acids and

fatty acids are reformed into more complex molecules such as glycogen, hormones,
enzymes or whatever the body needs for growth and maintenance of cells and tissues.

Glycogen is stored in the liver and muscles until needed at some later time when
glucose levels are low. If blood glucose levels are low, then eqinephrine and glucogon
hormones are secreted to stimulate the conversion of glycogen to glucose. This process
is called glycogenolysis (catabolism).

Catabolism begins with digestion and refers to the breaking down of large, complex
molecules into smaller molecules. Carbohydrates become monosaccharides, lipids
become fatty acids and glycerol, and proteins become amino acids. Catabolism also
occurs when old cells are broken down during maintenance and when energy is
released during intracellular catabolism.

ATP (adenosine triphosphate) is referred to as the molecular “currency” of the cells.

ATP is formed by the catabolism of glucose, glycerol, fatty acids, and amino acids. It
contains high-energy phosphate bonds that release a significant amount of energy
when ATP is broken down to ADP (adenosine diphosphate) and AMP (adenosine
monophosphate). ATP is regenerated by adding back phosphate groups through the
process of phosphorylation.

Metabolism consists of a series of chemical reactions called metabolic pathways.

The various metabolic pathways that occur take place in different parts of the cell,
depending on the various enzymes contained in those parts.

 The mitochondria often referred to as the “powerhouse” of the cell contains the
greatest number of metabolic enzymes and is the primary site where ATP is
made.

Two chemical reactions involving water are condensation and hydrolysis.

Condensation is typically an anabolic process which combines smaller molecules into

larger ones and water is released. 
Hydrolysis on the other hand is usually catabolic and involves breaking apart two
molecules by adding a water molecule.

GLCOLYSIS

Glycolysis is a series of reactions that extract energy from glucose by splitting it into
two three-carbon molecules called pyruvates. Glycolysis takes place in the cytosol of a
cell, and it can be broken down into two main phases: the energy-requiring phase and
the energy-releasing phase.

Energy-requiring phase in this phase, the starting molecule of glucose gets

rearranged, and two phosphate groups are attached to it. The phosphate groups make
the modified sugar—now called fructose-1,6-bisphosphate, allowing it to split in half and
form two phosphate-bearing three-carbon sugars.
Energy-releasing phase in this phase, each three-carbon sugar is converted into
another three-carbon molecule, pyruvate, through a series of reactions. In these
reactions, two  ATP molecules and one  NADH molecule are made.
In the second half of glycolysis, the three-carbon sugars formed in the first half of the
process go through a series of additional transformations, ultimately turning into
pyruvate. In the process, four ATP molecules are produced, along with two molecules
of NADH
GLYCOGENESIS
In the initial phase, glucose is phosphorylated into Glucose-6-Phosphate, a usual
reaction in glycolysis. It is catalyzed by glucokinase (liver) and hexokinase (muscle). An
enzyme Phosphoglucomutase will catalyze the conversion of Glucose-6-Phosphate and
is converted to Glcose-1-Phosphate.
Third step focuses on the reaction of Glucose-1-Phosphate to UTP thereby forming
active nucleotide UDP-Glcose (Uridine Diphosphate Glucose). The one responsible for
such reaction is the enzyme UDPGlcose Pyrophosphorylase.
A small fragment of already existing glycogen will serve as a primer in order to stimulate
the synthesis of glycogen. The glucose from UDP-Glcose will be accepted by
glycogenin. The initial glucose unit is attached to the hydroxyl group of tyrosine of
glyogenin. The first molecule of glucose is transferred to glycogenin, which will then
takes up for glucose residues forming a fragment of primer. It will be the one to accept
all glucose molecules.

Glycogen synthase transfers glucose from UDP-Glcose to glycogen (non-reducing end)

forming alpha 1,4-linkages.  The same enzyme catalyzes the synthesis of the
unbranched molecule with alpha-1,4-glycosidic linkages.The final step is the formation
of glycogen branches caused by the effect of branching enzyme.
GLUCOGENESIS

Basically Gluconeogenesis is the reversal of Glycolysis. Glycolysis proceeds to another

energy cycle called Citric Acid Cycle by forming a substance called pyruvate.

These 3 steps are circumvented by another set of enzymes to form glucose at the
end.

Substrates of Gluconeogenesis

 Glucogenic Amino Acids

 Lactate
 Glycerol
 Fatty acid
 Citric acid cycle

Glucogenic amino acid undergoes transamination which causes change in the carbon
skeleton and directly gets converted to pyruvate. Some Glucogenic amino acids form
oxaloacetic acid or other intermediates of Citric Acid Cycle. While alanine is preferred in
liver, glutamine is preferred in kidney.

Conversion of Glucogenic Amino Acids to Pyruvate

Muscular activities and anaerobic glycolysis in red blood cells produce a large amount
of lactate. This lactate is taken up by the liver and gets converted to pyruvate by the
enzyme lactate dehydrogenase.

Pyruvate then gets converted to glucose by hepatic Gluconeogenesis which is then sent
back to muscles for reuse. This is known as Cori Cycle.

Cori Cycle in Liver

Glycerol is formed by breaking down of triacylglecerol in the fatty tissue. It is then

carried to the liver where it gets converted to Pyruvate and enters Gluconeogenesis. 

Gluconeogenesis steps

 Gluconeogenesis starts either in mitochondria or cytoplasm through a series of

enzymatically catalyzed steps.
 Glucose is converted to glucose 6 phosphate by glucokinase/ hexokinase in
glycolysis
 Fructose 1 phosphate is converted to fructose 6 phosphate in glycolysis by
phosphorfructokinase
 Pyruvate is converted to phosphoenol pyruvate by pyruvate kinase in glycolysis
 Rests are steps of Glycolysis in the opposite direction towards glucose using the
same enzymes.
GLUCOGENOLYSIS

Action of glycogen phosphorylase

The key enzyme of glycogenolysis is glycogen phosphorylase which is aided by another

molecule called pyridoxal phosphate. This enzyme cleaves the glucose residues
sequentially and yield glucose 1 phosphate.

This cleavage is known as phosphorolysis which continues until 4 residues are

present on either side of a branching point. The resultant smaller and less branched
glycogen molecule, limit dextrins. It cannot be broken down further by Glycogen
phosphorylase.

Glycogen phosphorylase stereoisomers

Debranching enzyme is a single molecule consisting of 2 enzyme activities – α –

[1→4]→α-[1→4] glucan transferase and glucosidase. The first enzyme activity removes
the glycogen fragment containing 3 or 4 residues in a branch and move them to a
nearby chain.

This involves breaking up of 1→ 4 glycosidic link in one point and the formation of the
same at another point on the molecule.

The second enzyme activity breaks the 1→ 6 glycosidic link at the branching point and
release free glucose. Once the branching is lost, remaining linear fragment of glycogen
is available for the action of phosphorylase and the process continues.
Action of Debranching enzyme

Formation of end products

The glycogen in the liver is used to increase the blood glucose level when needed. The
glycogen in muscle is used to supply energy during muscle contraction as in physical
exercise and not to increase blood glucose.

The end products – glucose and glucose 1 phosphate are formed by the combined
action of the two enzymes: debranching enzyme and gllycogen phosphorylase.

The glucose 1 phosphate gets converted to glucose 6 phosphate by an enzyme

Phosphoglucomutase. The glucose 6 phosphate gets cleaved to glucose by glucose 6
phosphatase which is present in liver, kidney and intestine.

Steps of glucogenolysis

Stimulation of glucogenolysis

A tight regulation of glycogenolysis is needed to keep the blood sugar under check.
When the blood sugar and the energy levels are low, glycogenolysis comes into play.
Glucagon and epinephrine are the hormones which are secreted in low blood sugar and
when the body is in distress. 

These hormones act through an intermediate molecule called cAMP which is necessary
for the activation of Glycogen phosphorylase. This mechanism is commonly found in
liver.

In muscles, only epinephrine causes effective glycogenolysis and in muscles, there is

increased calcium inside the cells during muscle contraction .

This also results in activation of glycogen phosphorylase through a series of

complicated reactions which does not involve cAMP. Epinephrine is the hormone of
fight, fright and  flight. 

III. CASE STUDY

Mucopolysaccharidoses

The mucopolysaccharidoses are a group of inherited metabolic diseases caused by the

absence or malfunctioning of certain enzymes needed to break down molecules called
glycosaminoglycans - long chains of sugar carbohydrates in each of our cells that help
build bone, cartilage, tendons, corneas, skin, and connective tissue.
Glycosaminoglycans (formerly called mucopolysaccharides) are also found in the fluid
that lubricates our joints.

People with a mucopolysaccharidosis either do not produce enough of one of the 11

enzymes required to break down these sugar chains into proteins and simpler
molecules or they produce enzymes that do not work properly. Over time, these
glycosaminoglycans collect in the cells, blood, and connective tissues. The result is
permanent, progressive cellular damage that affects the individual's appearance,
physical abilities, organ and system functioning, and, in most cases, cognitive
development. 

Different Types

Mucopolysaccharidosis I or MPS I, is a rare genetic disorder that affects many body

systems and that leads to organ damage. It is caused by an alteration in the gene that
makes an enzyme called alpha-L-iduronidase. Because of this alteration, cells either
produce the enzyme in low amounts or cannot produce it at all. The enzyme is needed
to break down substances called “glycosaminoglycans” (GAGs) which are by-products
of chemical reactions in the body’s cells. If GAGs are not broken down, they build up in
the cell, eventually leading to cell, tissue, and organ damage.

Mucopolysaccharidosis II or MPS II, also called Hunter syndrome , is a rare disease

that's passed on in families. It mainly affects boys. Their bodies can't break down a kind
of sugar that builds bones, skin, tendons, and other tissue. Those sugars build up in
their cells and damage many parts of the body, including the brain. Exactly what
happens is different for every person.

Diagnosis

Clinical examination and urine tests (excess mucopolysaccharides are excreted in the
urine) are the first steps in the diagnosis of an MPS disease. Enzyme assays (testing a
variety of cells or blood in culture for enzyme deficiency) are also used to provide
definitive diagnosis of one of the mucopolysaccharidoses. Prenatal diagnosis using
amniocentesis and chorionic villus sampling can verify if a fetus is affected with the
disorder.

Treatment

Currently there is no cure for these disorders. Medical care is directed at treating
systemic conditions and improving the person's quality of life. Physical therapy and daily
exercise may delay joint problems and improve the ability to move. 

Changes to the diet will not prevent disease progression, but limiting milk, sugar, and
dairy products has helped some individuals experiencing excessive mucus. 

IV. REFERENCES

https://laboratoryinfo.com/glycogenesis/

http://chemistry.elmhurst.edu/vchembook/600glycolysis.html

http://cte.sfasu.edu/wp-
content/uploads/2012/01/2_Principles_of_Digestion_and_Metabolism.html

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-
Sheets/Mucopolysaccharidoses-Fact-Sheet

https://www.khanacademy.org/science/biology/cellular-respiration-and-
fermentation/glycolysis/a/glycolysis

https://med.libretexts.org/Courses/American_Public_University/APUS
%3A_An_Introduction_to_Nutrition_(Byerley)/Text/04%3A_Carbohydrates/3.3%3A_Dig
estion_and_Absorption_of_Carbohydrates