DIGESTION AND ABSOR[TION

OF CARBOHYDRATES.

Dr. S.S. WALVEKAR.

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• The food consists of carbohydrates, proteins, lipids, vitamins and minerals.

• The food is of mostly complex macromolecular form which cannot be

absorbed as such by the body.

• Hence it has to undergo ‘ Digestion’.

• It is the process involving the hydrolysis of large and complex organic

molecules of foodstuffs into smaller and preferably water soluble molecules
.

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 Digestion in the Mouth
• Digestion of Carbohydrate starts in the mouth, upon contact with saliva
during mastication.

• Saliva contains a carbohydrate splitting enzyme called salivary amylase , also

known as ptylin.

• It is α-amylase and requires Cl− ion for activation with an optimum pH of 6.7
(Range 6.6 to 6.8).The enzyme Acts briefly on dietary starch and glycogen
breaking some α-(1 → 4) bonds.α-amylase hydrolyzes starch into dextrins.

• However, ptylin action halts in the stomach when the pH falls to 3.0
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Drawback

• Shorter duration of food in mouth.

• Thus it is incomplete digestion of starch or glycogen in the mouth

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Digestion in the Stomach
• There is no enzyme to break the glycosidic bonds in gastric juice.
• However, HCl present in the stomach causes hydrolysis of sucrose to
fructose and glucose.
• Sucrose HCl Fructose + Glucose

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Action of α-amylase on starch or glycogen

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Digestion in Intestine

There are two phases of intestinal digestion:

1. Digestion due to pancreatic α-amylase

2. Digestion due to intestinal enzymes :

Sucrase

Maltase

Lactase

Isomaltase
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• Food bolus reaches the
duodenum from the stomach
where it meets the pancreatic
juice.

• Pancreatic juice contains a

carbohydrate splitting enzyme,
pancreatic amylase (amylopsin)
similar to salivary amylase.

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Pancreatic α-amylase
degrades dextrins
further

into a mixture of :

Maltose,

Isomaltose and

α-limit dextrin.

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• Pancreatic amylase, and salivary amylase, work in the optimum pH.( 6.7-
7.1).

• Both the enzymes require Chloride ions for their actions (Ion activated
enzymes).

• Main digestion takes place in the small intestine by pancreatic amylase.

• Digestion is completed by pancreatic amylase because food stays for a

longer time in the intestine.

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The end products of carbohydrate digestion are:

• Glucose

• Fructose

• Galactose

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Flow sheet of digestion of carbohydrates.

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 Absorption of Carbohydrates

Two mechanisms are responsible for the absorption of monosaccharides:

1. Active transport against a concentration gradient,

from a low glucose concentration to a higher concentration.

2. Facilitative transport, with concentration gradient ,

From a higher concentration to lower conc.

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 Active Transport

• The transport of glucose and galactose occurs by an active

transport.

• Active transport requires:

- Energy

- A specific transport protein

- Presence of sodium ions

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Transport of glucose, fructose, galactose, mannose.

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 Facilitative Transport

• Fructose and mannose are transported by a Na+ independent facilitative

diffusion process, requiring specific glucose transporter, GLUT-5.

• Movement of sugar in facilitative diffusion is strictly from a higher

concentration to a lower one until it reaches an equilibrium.

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• Glucose is transported into mucosal cells by a carrier mediated and energy
requiring process.

• Glucose and Na+ share same transport system which is referred as sodium
dependent glucose transporter.

• The sodium dependent glucose transporter ( SGLT-1) binds both Na and

glucose at separate sites and transport them.

• The concentration of Na+ is higher in the intestinal lumen compared to

mucosal cells.
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• Na+, therefore moves into cells along its concentration gradient and
simultaneously glucose is transported into intestinal cells.

• Thus Na+ diffuses into cell and it drags glucose along with it.

• The intestinal Na+ gradient is the immediate energy source for glucose
transport.

• The fructose and mannose are transported by a Na+ independent facilitative

diffusion process involving another specific glucose transporter GLUT-5.

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• The final result of the digestion of carbohydrates in the form of glucose is
transported into the cell as a source of energy.

• while fructose and galactose is transported directly into the liver for conversion
into glucose.

• If there is high blood glucose levels, then the insulin will stimulate change of
glucose into glycogen and stored in the liver or in the muscles, thus preventing
hyperglycemia.

• If blood glucose levels are low, the hormones glucagon will stimulate the process
of solving glycogen into glucose, thus preventing hypoglycemia.
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Disorders of digestion absorption of carbohydrate.

• The carbohydrate malabsorptive syndromes are frequently seen by

pediatricians.

• The congenital deficiency states are quite rare but adult type
hypolactasia and lactose intolerance following rotavirus infection are
recognized with increasing frequency by primary care physicians.

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Clinical significance of Digestion
• Lactose intolerance is the inability to digest lactose due to the
deficiency of Lactase enzyme.
• Causes
• Congenital Acquired during lifetime.
1) Primary
2) Secondary

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Congenital Lactose intolerance
• It is a congenital disorder

• There is complete absence or deficiency of lactase enzyme.

• The child develops intolerance to lactose immediately after birth.

• It is diagnosed in early infancy.

• Milk feed precipitates symptoms.

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Primary Lactase deficiency
• Primary lactase deficiency develops over time

• There is no congenital absence of lactase but the deficiency is precipitated during adulthood.

• The gene for lactose is normally expressed upto RNA level but it is not translated to form
enzyme.

• It is very common in Asian population. Lactose intolerance is also very common in

people of West African, Arab, Jewish, Greek, and Italian population.  

• There is intolerance to milk + dairy products.

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Secondary lactase deficiency
• It may develop in a person with a healthy small intestine during
episodes of acute illness.
• This occurs because of mucosal damage or from medications
resulting from certain gastrointestinal diseases, including exposure to
intestinal parasites such as Giardia lamblia.
• In such cases the production of lactase may be permanently
disrupted.
• A very common cause of temporary lactose intolerance is
gastroenteritis, particularly when the gastroenteritis is caused by
rotavirus.
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• Giardiasis  is an infection of the small intestine that is caused by the
parasite, Giardia duodenalis.

• Giardia is found on surfaces or in soil, food, or water that has

been contaminated with faeces from infected people or animals.

• If left untreated, Giardia will eventually lead to more acute symptoms,

including bloody diarrhea, weight loss, and dehydration. 

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• Another form of temporary lactose intolerance is lactose overload in infants.

• Secondary lactase deficiency also results from injury to the small intestine that
occurs with celiac disease, Crohn’s disease, or chemotherapy.

• This type of lactase deficiency can occur at any age but is more common in
infancy.

Crohn's disease is a type of inflammatory bowel disease (IBD). It causes

inflammation of your digestive tract, which can lead to abdominal pain, severe
diarrhea, fatigue, weight loss and malnutrition. 
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Biochemical basis.

• If an individual does not produce enough lactase (lactase deficient), then

undigested lactose passes through the small intestine to the large
intestine, where bacteria break it down, producing hydrogen gas and lactic
acid.

• This process can cause the affected person to experience abdominal pain
and bloating, flatulence (passing gas), and diarrhoea within 30 minutes to 2
hours of consuming milk or other dairy products.

• It results in In the form of abdominal cramps, distensions, diarrhoea,

constipation, flatulence upon ingestion of milk or dairy products.
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 Diagnosis

• Two tests are commonly used:

• - • Hydrogen Breath Test
• The person drinks a lactose loaded
beverage and then the breath is
analyzed at regular intervals to
measure the amount of hydrogen.
• Normally, very little hydrogen is
detectable in the breath, but
undigested lactose produces high
levels of hydrogen.
• The test takes about 2 to 3 hours

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• If average basal values of breath hydrogen is more than 16 parts per
million (ppm), it is generally considered as a high value.

• Positive diagnosis for a lactulose breath test – typically positive if the

patient produces approximately 20 ppm of hydrogen within the first
60–90 minutes (indicates bacteria in the small intestine).

•  The sensitivity and specificity of the lactulose hydrogen breath test

has been reported to be only 68% and 44%, 

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• Stool Acidity Test
• • The stool acidity test is used for infants and young children to
measure the amount of acid in the stool.
• Undigested lactose creates lactic acid and other short chain fatty acids
that can be detected in a stool sample.
• Glucose may also be present in the stool as a result of undigested
lactose.

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Methylamine test for lactose.

• Add 1.0 ml of a 0.2 % solution of methylamine hydrochloride ,

followed by 10 % sodium chloride to 5 ml of urine. Mix by inversion,
cover the tube with a glass bulb and heat at 560 C for 30 minutes.

• Remove from water bath and cool at room temperature.

• Urine containing much lactose shows red colour.

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Lactose tolerance tests
• Glucose blood test

• This is an alternate test sometimes used to detect and diagnose lactose intolerance.

• This test measures the glucose level in the blood samples taken immediately before
and after the lactose drink.

• Since lactose is normally broken down to glucose and galactose, taking the lactose
drink would normally lead to absorption of this glucose and result in an increase in
blood glucose.

• In persons with lactose intolerance, there is inadequate breakdown of lactose and

so this rise in blood glucose is not seen.
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• Besides these tests, urine shows positive test with Benedict’s test,.

• since lactose is a reducing sugar and a small amount of lactose is

absorbed in the intestinal cell by pinocytosis and is rapidly eliminated
through kidneys in to urine.(Lactosuria).

• Mucosal biopsy confirms the diagnosis

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• Avoidance of dairy products.
• Although the body’s ability to produce lactase cannot be changed,
the symptoms of lactose intolerance can be managed with dietary
changes.
• Most people with lactose intolerance can tolerate some amount of
lactose in their diet.
• Gradually introducing small amounts of milk or milk products may
help some people adapt to them with fewer symptoms.

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Lactose-free, lactose-reduced milk.

• Soy milk and other products may be recommended.

• Lactase enzyme drops or tablets can also be consumed.

• Getting enough calcium is important for people with lactose intolerance

when the intake of milk and milk products is limited.

• A balanced diet that provides an adequate amount of nutrients—

including calcium and vitamin D—and minimizes discomfort is to be
planned for the patients of lactose intolerance.
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Factors affecting rate of absorption of
Monosaccharides
• The absorption is faster through intact mucosa.

• The absorption is decreased if there is some inflammation or injury

to the mucosa.

• Thyroid hormones ↑ the rate of absorption of glucose.

• Mineralocorticoid,i.e Aldosterone ↑ the rate of absorption.

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• Vitamin B6,B12, pantothenic acid, folic acid are required for absorption
of glucose.

• With advancing age, rate of absorption declines.

• Insulin has no role in the absorption of monosaccharide like glucose

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2. Sucrase deficiency.

• The deficiency of the enzyme sucrase occurs along with that of

isomaltase because these two occur as a single enzyme complex.

• People with this condition cannot break down the sugars sucrose (a
sugar found in fruits, and also known as table sugar) and maltose (the
sugar found in grains).

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• The undigested sugar undergoes a process called “fermentation.”

• This fermentation results in increased gas production.

• When undigested substances are not absorbed in the colon, an osmotic

pull of water into the colon causes watery diarrhoea. 

• Symptoms are quite similar, such as diarrhoea and cramps, abdominal

pain, etc.
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