Digestion and Absorption

Dr Janetta Harbron RD(SA)

BSc Dietetics, MSc Nutritional Sciences, PhD Physiological Sciences
Janetta.Harbron@uct.ac.za

Debby Gates RD(SA)

BSc Dietetics
2 Military hospital, Department Paediatrics, Wynberg.
Outline
 Overview of the human digestive processes

 Digestion of macronutrients: carbohydrate, protein and fat

 Absorption of the end products of macronutrient digestion

 Absorption of micronutrients
Introduction
 Digestion involves mechanical and chemical processes

 Digestive effectiveness unaffected by random combinations of foods

 Wide variety of foodstuffs can be digested and absorbed: meats,

dairy, fruit, vegetables, grain, complex starch, sugars, fats and oils.

 Human gut has an efficiency of approx. 90 - 97%

(exception: some plant origin carbohydrates = dietary fibre)

 Absorptive capacity far exceeds normal intake

 Brush border
 200 – 300 m2 absorptive surface

valvulae conniventes villi microvilli

Brush border
 Enterocytes have 3 – 5 days lifespan
• 2-3 fully functional on distal third of villi

 High turnover rate make them vulnerable

• Nutrient deficiencies
• Malnutrition
• 45-70% of their energy needs directly supplied by
food
• Changes after few days of fasting
• Damage (toxins)
• Food allergy
• Interrupted blood supply
Overview

Mouth
 Particle size reduced
 Lubricated by saliva (1.5 L/day)
 Enzymatic digestion
• Amylase: hydrolysis of starch to dextrins & maltose
• Lingual lipase: hydrolysis of Triglyceride to diglyceride
and free fatty acids.
• Very little time to start digestion, deactivated in
stomach
 Bolus swallowed voluntarily, peristalsis takes over
from oesophagus
Overview

Stomach
 Food diluted with fluids (2 – 2.5L)
• HCL
• Pepsinogen: activated to pepsin - protein to peptides & amino acids.
• Gastric lipase: MCTs and SCFAs to diglyceride & free fatty acids
• Mucus
• Intrinsic factor: Vitamin B12
 Minimal absorption
 Germicidal action (pH 1-4)
 Controlled emptying of acidic chyme into small intestine (pyloric
sphincter)
 Stomach empties in 1 – 3 hours
Overview
Small intestine
 Duodenum 0.5m: secretions and digestion
 Jejunum 2-3m: digestion and absorption
 Ileum 3–4m: fluids (7L) and electrolytes, Vit B12, bile (95%)
 secretions from gallbladder, pancreas, duodenum epithelium
• Proteolytic enzymes (proteins)
• Pancreatic amylase (starch and dextrins)
• Pancreatic lipase (fats)
• Bile salts (lipids, cholesterol, Vit ADEK)
• Small intestine enzymes
 3 – 8 hours transit
 Ileocecal valve controls movement into colon
Overview

Large intestine
 1.5 m long (cecum, colon, rectum, anal tract)
 Secretion of HC03 to neutralize acidity
 Net fluid absorption of 2L, 150ml excreted
 Bacterial fermentation of protein, carbohydrate
 Vitamin production e.g. Vit K
 Mouth to anus transit 18 –72 hrs
 Stool consists of bacteria, GIT secretions, mucous,
sloughed cells, undigested foods
Carbohydrates: classification
Carbohydrates
 1-4 glycosidic linkages
Carbohydrate digestion
Mouth
Food chewed and mixed with salivary amylase
Starches hydrolysed to smaller dextrins
Stomach
Amylase inactivated by hydrochloric acid
Hydrochloric acid able to hydrolyse dextrins
completely to monosaccharides
BUT stomach empties before that happens
Small Intestine
Partially digested starches exposed to powerful
pancreatic amylase
Disaccharides exposed to intestinal enzymes of
brush border
Colon
Dietary fibre and resistant starch fermented by flora
Production of SCFA and gas
Carbohydrate digestion
 Carbohydrate absorption
 Glucose and galactose
• At low concentration: absorbed via active sodium glucose cotransporter (SGLT1)
• 1 glucose + 2 sodium + 210 molecules H20
• SGLT1 is key to ability intestine to absorption 7liters of water per day
• Mechanism through which glucose assist in fluid absorption in diarrhea
• At high concentration: absorbed via facilitative diffusion, transporter GLUT 2

 Fructose
• Facilitative transporter GLUT 5

 All cross basolateral membrane via GLUT2

Carbohydrate absorption
Intestinal Cell
lumen cytoplasm

Intestinal Portal
lumen Blood
 Proteins and Amino acids
 Large macromolecules
 Polymers built from series of different amino acids (monomers)
 Amino acid: molecule with a carboxyl (COOH) and amino group (NH2)
attached to -carbon
 20 Proteinogenic / standard amino acids
 300+ ‘other’ non-standard amino acids
are created from amino acids
• Carnitine
• Orinithine
• Citruline
• Aspartame
 Protein structure
 Amino acids linked together by peptide bonds
 Amino acids
 Different utilization / need for different amino acids
• Amino acids can be interconverted to some extent

 Essential amino acids needed for adequate protein synthesis

• Essential amino acids cannot be synthesized in adequate amounts

 Non-essential amino acids synthesized through interconversion

Protein digestion

Collagen
Protein absorption
 Several transport mechanisms for absorption of different amino
acids, small peptides
• Different sizes, polarity, configuration
• Some sodium- or chloride- dependent

 Active transport of dipeptides and tripeptides via peptide

transporters

 Large intact peptides also absorbed

• As proven by antibodies to specific food proteins
• E.g. allergies
• Mechanisms unclear
Protein digestion
Dietary protein
80-100g daily
Endogenous protein
50-60g daily
• Shed epithelial cells
(10 – 20 billion daily)
• Mucoproteins
All hydrolysed to small
• Digestive enzymes peptides and amino acids.
• Leaked plasma protein Virtually all absorbed
(1% in feces)
 Lipids

 Mainly in the form of triglycerides (97%)

 Cholesterol and phospholipids

Lipid digestion
Mouth
Food chewed and mixed with lingual lipase
Minimal digestion of fat by lingual lipase
Stomach
Gastric lipase partially digests SCFA and MCTs
to fatty acids and glycerol

Small Intestine
1. Secretion of bile acts as powerful detergent
emulsifying fats to smaller droplets (1L/day)
2. Peristaltic agitation maintains suspension
3. Exposure to pancreatic lipase, cholesterol esterase
4. Digestion of triglycerides to FFAs and monoglycerides
5. Micelle formation (small aggregates of fatty acids, bile
salts, cholesterol

Colon
Stool: < 10% unabsorbed fatty acids
Fat digestion
Fat absorption
 Fat absorption
 Passive diffusion and facilitate transport used to cross into enterocyte
 New triglycerides forms in enterocyte
 TGs, cholesterol, fat soluble vitamins, phospholipids surrounded by ‘protein
coat’ (lipoprotein)
 Lipoprotein globule passes into lymphatic system
 Enters circulation via thoracic duct
Fat absorption
Medium chain triglycerides (12C or less)
Small size increases solubility

Absorbed directly into

mucosal cell without bile or
micelle

Pass from mucosal cell into

portal vein without
esterification
 Vitamins & minerals: absorption
 Released from foods with digestion of macronutrients
 Often needs to be cleaved or activated with enzymatic action prior to
absorption
 Absorption occurs mainly in small intestine
 Each micronutrient has a specific mechanism for absorption
 Passive transport
• Typically at high concentrations
 Active transport proteins
• Low concentrations, potentially toxic substances
 Some have high and others low bioavailability (5 – 100%)
 Vitamins and minerals
Factors that can influence absorption efficacy (bioavailability)
 Binding of nutrient to another substance like phytates, oxalates, medication, fatty
acids, other minerals that prevents absorption
 pH
• Iron, Calcium, Vit B12
 Competition around active transporter with another nutrient
• E.g. divalent cations Zn ,Mg, Ca, Cu, Cb & Fe
 Nutritional need / deficiency / excess supply / hormonal control
• E.g. calcium, iron, zinc
 Presence of other nutrients can also enhance absorption
• e.g. lactose for calcium, Vitamin C for iron
 Form of Vitamin / Mineral in food
• e.g. ferric vs. ferrous iron
• Phosphate as part of phytate in plant foods, unable to digest
 Vitamins
 Iron
• Absorption can be increased based on demand (women, pregnancy)
 Fat soluble vitamins A, D, E K
• Absorbed via micelle formation
• Needs the presence of fat, lipase & bile for absorption
• Requires bile reabsorption
 Calcium
• Vitamin D, blood calcium levels, PTH regulates GIT absorption
Vitamin B12
• Dependent on stomach acidity and secretion of intrinsic factor in the stomach
 Text book references
 Krause’s Food and the Nutrition Care Process. Mahan, Escott-Stump &
Raymond. 14th Edition, 2016. Chapter 1

 Biochemical, Physiological and Molecular aspects of nutrition. Stipanuk &

Caudill. 4th edition, 2018.