Nutritional Biochemistry: Carbohydrates and its Role in Human Nutrition

Arcilla, Edward Ashley T., Adao, Celine O., Boado, Kathleen Joyce O., De Guzman, Margaret Alexa C., Gandola,
Kherson P., Marquez, Mark Christian E., Ong, Jehiel Karsten H., San Luis, Pia Lorraine F., Tañas, Trisha Joy M.
4C-Biochemistry

OUTLINE​​______________________________
I. Carbohydrate Chemistry: Structure, Function 2. Protein sparer
and Classification - since Carbohydrates is the primary source of
II. Carbohydrate Nutritional Processes ATP, it spares glucogenic amino acid from
III. Glucose Metabolism degradation to produce ATP.
IV. Molecular Conditions for galactosemia, lactose 3. Regulator of fat metabolism
intolerance, diabetes and hypoglycemia - too much carbohydrate intake generates too
much pyruvate in which it will be converted
LEARNING OUTCOMES​​____________________ into acetyl coa. These acetyl coa will be used
● Recognize the chemical nature of as backbone for triacylglycerides (TAG)
carbohydrates production as well as cholesterol synthesis.
● Describe carbohydrate consumption, sources - in mevalonate pathway, acetyl coa is used as
and recommendations substrate
● Classify carbohydrates and discuss its functions 4. Sole energy source for the brain and nerve
and transformations tissues
● Explain the carbohydrate nutritional processes 5. Storage form of energy as glycogen in animal
● Illustrate the body’s use of glucose tissues
● Examine the molecular conditions for 6. Regulator of intestinal peristalsis and provider
galactosemia, lactose intolerance, diabetes and of bulk
hypoglycemia
NON-ENERGY RELATED FUNCTIONS​​_________
I. Carbohydrate Chemistry: Structure, Function
and Classification 1. important constituents of ​tissue antigens
2. important constituents of ​ribonucleic acids
CARBOHYDRATE​​________________________ 3. important constituents of ​interstitial fluid
matrix ​in the form of glycoprotein
- In general, carbohydrates are foods that refer 4. important constituents of ​brain and nerve
to ​starches​​ and ​sugars. tissues ​ in the form of
- They furnish the ​major source of energy and
form the ​bulk of the diet​​ around the world. CLASSIFICATIONS​​_______________________
o 50-60% in developed countries
o 75-80% in the Philippines and other Carbohydrates are classified into two – ​Simple
oriental countries carbohydrates and Complex Carbohydrates​​:
- major sources of carbohydrates are from
plants, liver glycogen, milk and processed
foods​​.
- in photosynthesis, carbohydrates specifically
glucose are synthesized from the ​Calvin cycle
which happens in the stroma.

DEFINITION​​_________________----______--

- Carbohydrate means ​“hydrate the carbon”

- General formula: ​(CH​​2​​O)n
- structurally are ​polyhydric aldehydes and
ketones​​; the simplest unit is the saccharide or
sugar unit.
- Dietary carbohydrates 1. SIMPLE CARBOHYDRATES
o polysaccharides (plant starches & liver Further subdivided into ​monosaccharides ​and
glycogen) disaccharides
o disaccharides
o simple sugars a. MONOSACCHARIDES
o dietary fiber - structurally the simplest form of carbohydrate
- it cannot be reduced in simpler form and smaller
FUNCTION​​_________________--------______ carbohydrate units by hydrolysis
- ​Glucose ​is the most abundant monosaccharide in
1. Chief source of energy nature
- it is the primary source of ATP (adenosine
triphosphate)
 - these are sweetening agents
Examples of monosaccharides: - mannitol – have the same sweetening power
as glucose; food ingredient. It yields 2
kcal/gm.
- sorbitol - have the same sweetening power as
glucose; used to delay onset of hunger and it
absorb more slowly. It yields 4 kcal/gm.

How alcohols are formed from sugar moieties?

Examples:
glucose ​→ ​glucitol (reduction)
aldose ​→​ alditol (reduction)
aldose → aldaric acid (oxidation)
aldose → aldonic acid (oxidation)
Additional notes:
● Aldonic acid is formed by oxidation of aldehyde
functional group while formation of aldaric acid
1. Glucose is caused by oxidation of the aldehyde group at
- also known as
Carbon 1 as well as the hydroxyl group at the
dextrose or grape sugar. (it
terminal carbon.
is named as dextrose since in
terms of polarimetry, it spins
b. DISACCHARIDES
dextrotatory​​)
- two monosaccharide ​units joined by
- principal product of covalent bonds
starch and cane sugar
- Sucrose: nutritionally the most significant,
hydrolysis
approximately one-third of total dietary
- the ​circulating carbohydrate in an average diet
carbohydrate​​; most important sugar in
human metabolism
Examples of disaccharides:
o circulating carbohydrate in the
bloodstream since it is used as a fuel 1. Sucrose
to produce ATP
- oxidized in the cells to release energy

2. Fructose
- sweetest of all
sugars and is found - α(1,2) glycosidic bonds
pre-formed in honey, - known as ​cane sugar or table sugar but also
ripe fruits and some abundant in in molasses, maple syrup,
vegetables sorghum
- hydrolyzed from - most common form in cooking and table
sucrose and inulin serving
- also known as - hydrolyzed into glucose and fructose
levulose. (it is (invert sugar)
named as levulose since in terms of
polarimetry, it spins ​levorotatory​​) 2. Maltose

3. Galactose

- not found free in

nature but ​hydrolyzed from - also called malt sugar (derived from the
lactose digestion of starch)
o found in milk - does not occur free in nature but can be
(contains lactose) hydrolyzed by amylases from starches and
- also a component of cereal grains
cerebrosides found in brain - usually combined with dextrin for infant milk
and ​nerve tissues formula

4. Sugar alcohols 3. Lactose

- known as the ​milk sugar

- least sweet
 - can be fermented by bacteria in the intestines 2. Glycogen
that causes a ​laxative effect - animal starch​​; storage
form of carbohydrate in
2. COMPLEX CARBOHYDRATES liver and muscle
Further subdivided into ​oligosaccharides ​and - more highly branched
polysaccharides than amylopectin
- muscle​​: used directly
a. OLIGOSACCHARIDES to supply energy
- consist of short chains of monosaccharide units - liver​​: changed to
(3-10 CHO units) that are also joined by glucose and circulated
covalent bonds - in foods, it is limited to
- Trisaccharides occur most frequently in liver and oysters and only minutes after
nature slaughter of the animal; readily converted to
- raffinose is composed of fructose, galactose lactic acid
and glucose
II. Carbohydrate Nutritional Processes

CARBOHYDRATE DIGESTION​​______________
The objective of carbohydrate or starch
digestion is to ​separate all disaccharides and
complex starches into monosaccharides for
absorption​​, in spite of the fact that not all are totally
absorbed in the small intestine (e.g., fiber).

b. POLYSACCHARIDES
- are long chains of monosaccharide units (>10
CHO units) that may extend to a number of
hundreds or even thousands
- major polysaccharides of interest in
nutrition:
• Animal tissues: ​glycogen
• Plant: ​starch and cellulose

Examples of polysaccharides:

1. Starch
- world’s most abundant In the Mouth
and cheap form for carbohydrate Carbohydrate absorption starts in the mouth.
- storage form of The salivary glands in the mouth discharge salivation,
carbohydrate in plants which saturates the food. The food is then bitten while
- have two components: the salivary glands additionally discharge the protein
amylose and amylopectin salivary amylase, which starts the process towards
- Amylose has α(1,4) separating the polysaccharides in the carbohydrate
glycosidic bonds and are linear food.
while amylopectin has α(1,4)
and α(1,6) glycosidic bonds and
are branched.
- partial hydrolysis: dextrin and maltose;
complete hydrolysis:​​ glucose
In the Stomach Summary
After the carbohydrate food is bitten into little
pieces and blended with salivary amylase and other
salivary juices, it is gulped and gone through the
throat. The mixture enters the stomach where it is
known as ​chyme​​. There is no further absorption of
chyme, as the stomach produces corrosive which
destroys microscopic organisms in the food and stops
the activity of the salivary amylase.

In the Pancreas and Small Intestine

After being in the stomach, the chyme enters
the starting bit of the small intestine or the duodenum.
In light of chyme being in the duodenum, the pancreas
CARBOHYDRATE ABSORPTION​​_____________
discharges the catalyst ​pancreatic amylase​​, which
separates the polysaccharide into a disaccharide​​,
1. ​Monosaccharides, the end products of
a chain of just two sugars connected together. The
small intestine at that point produces enzymes called carbohydrates digestion enter the
lactase, sucrase, and maltase, which ​separate the capillaries of the intestinal villi. Then it
disaccharides into monosaccharides​​. The travels to the liver via the portal vein.
monosaccharides are single sugars that are then
2. Na+ ATPase powered symport pumps
invested in the small intestine.
both glucose and sodium into the cell
In the Large Intestine (Colon) through the cell membrane.
Carbohydrates that were not processed and 3. Sodium is moved from the epithelium cell
consumed by the small intestine goes to the colon into the bloodstream by a Na+/K+ ATPase,
where they are mostly separated by intestinal
and K+ is moved from the blood back into
microscopic organisms. Fiber, which can't be processed
like the other carbohydrates, is discharged with the cell .
defecation or somewhat processed by the intestinal
microorganisms. Monosaccharides absorbed into the intestinal mucosa
cell by ​active transport​​ and ​facilitated transport.

ACTIVE TRANSPORT
- ​Requires energy as ATP
- ​Glucose binding site is not available
unless the transport protein has already
bound a Na+
- ​Na​+​/K​+ ATPase then ​“​pumps” the Na ions
back out of the cell
- ​3 Na​+​​ ​ for 2 K​+
​
- ​Sodium binds to transporter
- ​Induce conformational change, glucose
can bind and go to the cell via symport
mechanism.
Sodium-Glucose Transporter 1 (SGLT1) Features of transporter protein:
- ​Transports glucose and galactose ● has a ​specific site for the molecule being
to enterocyte transported
- ​Symporter: Na+ and glucose or galactose ● undergoes a ​conformational change upon
- Mutation in the SGLT1 gene is associated with binding the molecule: ​allow translocation
glucose-galactose malabsorption ● h​​as the ability to ​reverse the
conformational changes
(a) Active Transport - ​Goes back to its original form in order to
be reused

GLUT2
- Low affinity
- Predominant expression in the Beta-cells of the
pancreas, liver, small intestine, and kidney
- Rate of transport is highly dependent upon the
blood glucose concentration
- In the pancreas, GLUT2 appears to be the
sensitive indicator of blood glucose level

High Blood Glucose, High Release of insulin

GLUT3
- High-affinity glucose transporter with
predominant expression in those tissues that
are highly dependent upon glucose, such as
the brain and neurons
- ​Major site of expression: Brain (neurons)
- Sugar as primary substrate, constant
uptake
FACILITATED TRANSPORT GLUT4
- Insulin-dependent glucose transporter in
Glucose transporters (GLUT) muscle and adipose tissue
- ​Protein carriers involved in the transport - Other cells and tissues do not express GLUT4
of glucose and other monosaccharide units and not dependent upon insulin for glucose
- ​Total of 14 individual glucose transport uptake
proteins - Major site of Expression: Muscle, Heart, brown
- ​28% of the amino acid sequences are and white adipocytes
common within the family - Require high energy
- ​Each GLUT is an integral protein - Once insulin is bound, it phosphorylates and
- ​12 transmembrane alpha-helix segments then there is a cascade of reactions that
undergo phosphorylation. This aid in
translocation of GLUT4 into the membrane to
accept more glucose molecules

High Glucose, High GLUT4 translocated

GLUT5
- Specific for transport of fructose and will not
transport of glucose
(b) and (c) Facilitated transport insulin. When insulin is formed, it binds to the
receptors found in the cell membrane of muscle cells
and adipocytes; to allow GLUT4 to be translocated
across the cell membrane. When glucose is transported
and blood glucose levels have normalized, production
of insulin stops.
In addition, as the body’s cell utilizes glucose,
blood glucose level decreases which therefore
stimulates the α-cell of the pancreas to release
glucagon to the bloodstream. Glucagon will now
stimulate the liver cells to breakdown glycogen and
release glucose in the blood which results to increase
in blood glucose level.

CARBOHYDRATE DISTRIBUTION​​____________
- also referred to as carbohydrate transport.

Overview:

General scheme:
↑Glucose level → GLUT2 triggers production of
insulin by the pancreas → Insulin binds to membrane
receptors → Translocation of GLUT4.

III. Glucose Metabolism

INSULIN ACTION​​_______________________

Insulin causes glucose uptake in the muscle to

Upon digestion and absorption of a glucose increase and this is facilitated by GLUT4, insulin also
unit and/or other monosaccharides, these molecules increases glucose uptake in the liver and glucokinase
go directly to the bloodstream and then to the liver. concentration, which is facilitated by GLUT2. Increased
The high concentration of glucose in the bloodstream glycogen synthesis and decreased glycogen breakdown
allows GLUT2 to trigger the pancreas to produce in the liver and muscle causes an increase in glycogen
synthase and a decrease in glycogen phosphorylase,
respectively. Increased breakdown of glucose and
production of acetyl-CoA in the liver and muscle causes
an increase in PFK and PDC. And lastly, insulin causes
increased fatty acid synthesis and subsequent increase
in Acetyl-CoA carboxylase.

FATE OF GLUCOSE​​________________________

The major pathways shown in this diagram are

glycolysis, the TCA cycle, and the pentose phosphate
pathway. Glucose is considered as source for fatty acid
synthesis and can be stored as glycogen in liver and FATE OF GALACTOSE:
skeletal muscle. Once ​glucose is in the cell, it is lactose → galactose → gal-1-phosphate → UDP-gal →
phosphorylated to ​glucose-6-phosphate. UPD-glucose
Glucose-6-phosphate is at the crossroads of glucose
metabolism and can be ​diverted into one of three The galactose will be charged with UDP, which is a
pathways: glycogen synthesis, glycolysis and the good charging molecule, and will undergo
PPP. epimerization to form UDP-glucose. From here, it will
be converted into glucose-1-phosphate where it can
● Acetyl CoA – for cholesterol and fatty acids enter glycolysis.
synthesis
● Higher glucose level, G6P proceeds to FATE OF FRUCTOSE:
glycogenesis​​(formation of glycogen) or to fat Fructose can either be converted to
synthesis fructose-6-phosphate or fructose-1-phosphate before it
● Lower glucose level, G6P proceeds to can enter glycolysis
glycogenolysis​​ ( breakdown of glycogen)
● Pentose Phosphate Pathway generates NADPH, FATE OF MANNOSE:
pentoses (5-carbon sugars) and Mannose can be isomerized into fructose-6-phosphate
ribose-5-phosphate which is a precursor for the and will undergo glycolysis
synthesis of nucleotides. TCA cycle produces
energy through oxidation of acetyl-CoA. The GLYCEMIC RESPONSE TO CARBOHYDRATES
energy produced comes in the form of NADH
and FADH2. GLYCEMIC INDEX​​________________________

- it is a ​relative ranking of carbohydrates in

foods according to how they affect blood
glucose level.
- increase in blood glucose level above the
baseline level following the consumption of a
defined amount of carbohydrate ​compared
 with the same amount of carbohydrate in
a reference food​​. GLYCEMIC LOAD​​_______________________

- related quantitative measure which considers

both the quantity and the quality of the
carbohydrates in food.

Glycemic Index (GI) Value GL = ( GI of CHO x g of CHO per serving) ​÷ ​100

Low GI 0-55
EXAMPLE: ​Carrots have a GI of 47 and 5 g CHO per
serving
Moderate GI 56-69
The GL of carrots is: (47 × 5) ÷ 100 = 2.4
High GI ≥70
Glycemic Load Value

● Carbohydrates that break down easily during Low GL 0-10

digestion have ​higher GI. ​They release their
glucose into the blood quickly ​(e.g: baked Moderate GL 11-19
potato)
● Carbohydrates that break down slowly during High GL ≥20
digestion have ​lower GI ​that can help with
satiety feeling​. ​They release their glucose into
the blood slowly.​ ​(e.g: oats) FACTORS AFFECTING GLYCEMIC INDEX​​______

The faster the food gets converted into

glucose, the higher the GI of the food will be. The body
may not rapidly respond to match the release of
glucose into the blood after eating too much
carbohydrate-containing food, thus, their blood glucose
level may increase above the normal levels faster.
Certain factors affecting glycemic index will be
discussed further.

1. Type of Starch
a. Amylose
- absorbs less water molecules
- forms tight clumps
- slower rate of digestion
- lower GI
- example: kidney bean
b. Amylopectin
- absorbs more water
- more open
- faster rate of digestion
- higher GI
- example: Russet potato

Rationale​: Starch is composed of two types of

molecules – amylose and amylopectin. Amylose isn’t
readily digested, which is why its rate of digestion is
slower as compared to amylopectin. The formation of
tight clumps causes the ingestion, digestion and insulin
response time to slow down, thus providing a lower GI.
In addition to this, amylose is insoluble in water, thus,
it absorbs less water molecules than amylopectin.

Ideally, ​foods that have a lower GI should be chosen

as they cause a relatively gradual rise in blood sugar.
​2. Physical Entrapment Simple sugars such as sucrose are readily
absorbed by the body and increase blood glucose
levels rapidly; whereas complex carbohydrates such as
starch take time to be absorbed by the digestive tract
of organisms, thus, blood glucose levels still increases
but at a slower rate.

Examples of Sugar and their GI

- physical entrapment of a food affects the

ability of the food to be absorbed in the body.

Rationale​: Based on the illustration, bran is the outer

shell that protects the seed. It acts as the ​physical
barrier which slows down enzymatic activity on
the internal starch layer during digestion. 5. Fat and Protein Content
- fat and protein slow down gastric emptying
Grains that are in their original form such as whole and slows down starch digestion.
wheat and barley have a lower GI than other forms of - high fat and protein foods have lower GI.
such substances like refined flours. By contrast, corn
flakes, a high GI food, lack the physical barrier making Rationale​: ​If gastric emptying​, a process wherein the
it more quickly absorbed by the body since enzymatic food exits the stomach to enter the duodenum, ​is
activity is not disturbed. slowed down, the food matter is absorbed more slowly
by the body which then reduces the blood glucose
Examples: levels.
Lower GI – All Bran, Pumpernickel bread Examples:
Higher GI – Bagel, Corn Flakes Lower GI – Peanut M&M’s, Potato chips, Special K
Higher GI – Jelly beans, Baked potato, Corn Flakes
3. Viscosity of Fiber
- viscous, soluble fibers transform intestinal 6. Food Processing
contents into gel-like matter that slows down - ​highly processed foods such as quick,
enzymatic activity on starch. 1-minute oats require less digestive processing and
contains a ​higher GI.
Rationale​: As said earlier, bran, which is composed
mainly of fiber, has a low GI. Thus, in this third factor Rationale​: The GI of a food will be raised significantly
affecting GI, which is the viscosity of the fiber, it states by the amount of pounding, mixing or grinding it
that ​highly soluble fibers found in apples and rolled endures, which is because ​the particle size is greatly
oats have ​lower GI. reduced​, so the body does not need to do as much
work to break down the food during digestion. Once
Soluble fiber lowers the ​GI of a food in different high-GI foods are absorbed by the body, it causes a
ways. When it mixes with liquid and with the digestive sudden spike in the blood glucose level.
juices, it forms a ​gel which slows the rate at which
your stomach empties. Once in the small intestine, 7. Cooking
that gel forms a protective layer around starch - cooking swells starch molecules and softens
particles, making it difficult for the enzymes to foods, which speeds up rate of digestion. However,
penetrate. overly cooked foods have higher GI.

Examples: Rationale​: Starch molecules are insoluble in water but

Lower GI – Apple, Rolled oats when put into boiling, these starch granules begin to
Higher GI – Whole wheat bread, Cheerios absorb water that eventually leads to swelling of starch
grains. The ​cooking process speeds up the rate of
4. Sugar Content digestion giving rise to higher levels of blood
glucose. ​Thus, the time it takes to cook food affects
its GI, in such a way that overly cooked foods with
swollen starch granules implies a higher rate of
digestion. Mashed potato has a higher GI than a whole
baked potato.

Examples:
Lower GI– Al dente spaghetti (boiled 10 to 15 minutes)
Higher GI– Over-cooked spaghetti (boiled 20 minutes)
 enzymes​​, caused by mutations in different
Summary: Low GI carbohydrates allow for larger genes
portions while regulating the blood glucose levels. It - since it is a genetic disorder, there is no
will typically prompt a moderate rise or increase in the treatment. Proper management and control on
blood glucose level. Whereas carbohydrates having galactose intake is needed
higher GI require smaller portions but causes the blood Galactose
glucose level to increase above the optimal level. - a monosaccharide
- C-4 epimer of glucose
GLUCOSE TOLERANCE​​_____________________
TYPES OF GALACTOSEMIA:
- determined by the rate at which the inherent
mechanisms for removing excess glucose from
the blood perform their functions Deficient
Type Name Gene
- measured by following ​blood glucose Enzyme
concentrations 2 hr after an oral load of
50-100 g glucose (given after fasting Galactose-1-ph
Classic
overnight) Type I osphate uridyl GALT
Galactosemia
- the observation is determined by the following: transferase
● the capacity of the body to ​secrete
adequate amounts of insulin Galactokinase
Type II galactokinase GALK1
● the availability of other ​nutritional deficiency
factors necessary for insulin binding
and effectiveness UDP-Galactose
Type UDP-galactose-
● the ​rate of insulin catabolism -4-epimerase GALE
III 4-epimerase
● the presence of ​insulin antagonists deficiency
● the release of ​counter regulatory
factors i.e., glucagon to halt
continuing fall of glucose after effect of
insulin has been accomplished
- normal levels of blood glucose: ​70-105 mg/dl

TYPE 1 Galactosemia
- more prevalent type compared to other two
types
- Galactose-1-phosphate uridyl transferase is the
deficient enzyme in which this functions for
Diabetic person:
gradually increases plasma glucose level as time after transferring uridyl phosphate to galactose
oral glucose intake increases TYPE 2 Galactosemia
- There is a galactokinase deficiency which is
IV. Molecular Conditions for Galactosemia, responsible for the phosphorylation reaction of
Lactose Intolerance, Diabetes and Hypoglycemia galactose
TYPE 3 Galactosemia
- deficient in the UDP-galactose-4-epimerase in
GALACTOSEMIA ​__________----____________
which UDP-galactose cannot be further
converted to UDP-glucose
- refers to a group of ​inherited disorders that
impair the body's ability to ​process and
produce energy from a ​sugar called SYMPTOMS:
galactose
Type I
- genetic metabolic disorder following an
autosomal recessive mode​​ of inheritance - most common and severe type
- cognitive impairment
- consumption of galactose will lead to its build
- dysmetria (a type of Ataxia)
up in the blood
- galactose is present in many foods, including - ataxia (incoordination of voluntary muscles)
- hepatic failure (accumulation of galactitol)
dairy products and some fruits and vegetables
- renal failure
- impaired ability to process galactose can
be due to the ​deficiency of any of 3 - cataracts
Type II MECHANISM OF ACTION
- typically causes only cataracts

Type III
- symptoms and severity depends on whether
the deficiency is confined to certain types of
blood cells or is present in all tissues
- symptoms may be similar to type classic
galactosemia

INHERITANCE:

Normal Lactose Digestion

- The enzyme lactase will cleave the ß(1,4)
linkages of glucose and galactose
- The monosaccharides will be then absorbed
into the blood and used as a source of energy

Lactose Intolerant
- Due to the deficiency with the enzyme lactase,
Autosomal Recessive the lactose was not cleave
- two copies of an abnormal gene must be - The lactose was transferred to the small
present in an individual in order for the disease intestine and to the large intestine
or trait to develop - The microbiome found in the large intestine
will ferment the lactose, producing acid and
LACTOSE INTOLERANCE​​__________----______ gases
- This acid and gases produced will cause
- Also called ​lactose deficiency or irritation to the colon which yields to the
hypolactasia different symptoms of lactose intolerance
- Different from galactosemia, because the
lactose here was not degraded by the TYPES OF LACTASE DEFICIENCY
enzyme lactase ● Primary lactase deficiency
- It is the ​inability of the body ​to digest and - It is a ​genetically determined absence or
metabolize lactose decrease in the enzyme is noted
● Secondary, acquired or transient lactase
Lactose deficiency
- is a disaccharide of ​ß – D – galactose and ​ß – D - This deficiency is due to the small intestinal
– glucose in ​ß​(1,4) linkage. mucosal disease, abnormalities of brush border
- Human milk contains 200 mmol/L of lactose cells and transport processes.
- It is digested by the enzyme lactase to form - It causes abrasion in colon and problems in
glucose and galactose in the brush border of intestinal microflora
the intestine.
SYMPTOMS:
Lactase - Abdominal bleeding and cramps
- an enzyme that cleaves the ​ß​(1,4) linkages of - Flatulence
glucose and galactose found in the lactose. - Diarrhoea
- Nausea
NOTE: Lactose intolerance is not an allergy because it - Borborygmi (rumbling stomach)
is not an immune response but instead it is caused by - Vomiting (particularly in adolescents)
lactase deficiency.
DIABETES MELLITUS​​---------------------------------
- group of metabolic disorders characterized by
an ​elevated blood glucose concentration
and ​disordered insulin metabolism
(defects in secretion, action or both).
 FEATURES OF TYPE 2 DIABETES:
● Prevalence in diabetic population: ​90% to
95% of cases
● Age of Onset: ​>45 yrs. old
● Associated conditions: ​Obesity, aging,
inherited factors
● Major defect: ​Insulin resistance, Insulin
Deficiency
● Insulin Secretion: ​Varies; may be normal,
increased or decreased
● Requirement of Insulin Therapy:
Sometimes
● Other names: Adult-onset diabetes, Non
insulin-dependent diabetes mellitus,
Ketosis-resistant diabetes

SYMPTOMS:
- Frequent Urination (Polyuria)
- Dehydration, Dry mouth
- Increased thirst (Polydipsia)
- Blurred vision
- Increased infections
- Weight loss
- Increased hunger (Polyphagia)
- Fatigue

TYPES OF DIABETES

Galectin 3
- ​binds to insulin receptor → insulin resistance
TYPE 1 Diabetes - a genetic disorder and an - chemotaxis marker for macrophage
autoimmune disease where immune cells attack beta - if insulin binds, it is unstable and do not cause
cells cascade series of reactions → no GLUT 4 → no glucose
TYPE 2 Diabetes - ​acquired from lifestyle
Gestational - occurs in pregnant and lactating
Examples of anti-diabetic drugs:
women. Hormones affect the binding of insulin
receptor → no GLUT 4 → no glucose
Drug Mode of action
FEATURES OF TYPE 1 DIABETES:
● Prevalence in diabetic population: 5% to Alpha-glucosidase Delay carbohydrate
10% of cases absorption
● Age of Onset:​​ <30 yrs. old
● Associated conditions: Autoimmune Amylin analogs Suppress glucagon
diseases, viral infection, inherited factors secretion, delay stomach
● Major defect: Destruction of Pancreatic Beta emptying, suppress
Cells, Insulin Deficiency appetite
● Insulin Secretion:​​ Little or none
● Requirement of Insulin Therapy​​: Always Biguanides Inhibit liver glucose
● Other names: Juvenile-onset diabetes, production, improve
Insulin-dependent diabetes mellitus, glucose utilization
Ketosis-prone diabetes
 D-phenylalanine Stimulate insulin
derivatives secretion by pancreas

DPP-4 inhibitors Suppress glucagon

secretion, delay stomach
emptying, suppress
appetite

Incretin mimetics Suppress glucagon

secretion, delay stomach
emptying, suppress
appetite

Meglitinides Stimulate insulin

secretion by pancreas

Sulfonylureas Stimulate insulin

secretion by pancreas

Thiazolidinediones Decrease insulin

resistance

Non-nutritive sweeteners
- use of NSS has the potential to reduce overall
calorie sweeteners without compensation on
intake of additional calories from other food
sources

People with diabetes should limit or avoid intake of

Sugar sweetened Beverages to reduce the risk for
weight gain.