Carbohydrate

Metabolism
 Prof. Nebal Abdel Rahaman Aboul Ella,
Clinical Nutrition consultant
Member of Egyptian fellowship board of clinical
nutrition
National Nutrition Institute
 Carbohydrate
Nutrition and Metabolism
• General characteristics
• Sources of carbohydrate in the diet
• Structures
• General functions of carbohydrate
• Glucose as major source of energy (Predominant Energy Pathways)
• Glucose from dietary carbohydrate:
digestion, absorption, transport into cells
• Glucose metabolism: glucose disposal & synthesis:
Nutrients include …..
 Carbohydrates are a major
fuel provider during exercise
General characteristics
• The term carbohydrate is derived from the french:
hydrate de carbone.

• Basic chemical structure consists of sugar units

• Compounds composed of C, H, and O

• C6H12O6

• Not all carbohydrates have this empirical formula:

deoxysugars, aminosugars
Glucose Structure

OH H
HO OH

H OH

■often shown as linear

structures, but exist in
nature as ringed structures
Sources of carbohydrate:
Sucrose: “sugar”
Lactose: milk
Maltose: beer
Fructose: fruit, honey
Starch (amylose & amylopectin): wheat, rice,
corn, barley, oats, legumes....
Glycogen: muscle and liver
• The function of carbohydrate is ...

Providing energy and regulation of

blood glucose - ATP synthesis (~ 4 kcal/g)
(eg for the brain, muscles)

Sparing the use of proteins

for energy

Fat synthesis: via acetyl-CoA

• The function of carbohydrate is ...
Glycogen synthesis
Digestive health - fibre

Krebes cycle intermediates

NEAA synthesis: carbon skeleton

Flavor and Sweeteners

• Structures (Usually by the number of sugar units in the
molecule)
Monosaccharides:

Glucose, fructose, galactose

Dissacharides:

maltose: glucose + glucose

lactose: glucose + galactose
sucrose: glucose + fructose
Polysaccharides:

amylose: glucose + glucose +.... (linear)

amylopectin: glucose + glucose +.... (branched)
glycogen: glucose + glucose +...(very branched)
 Structural formula of glucose

• You need to be able to recognise this

Actually called a-glucose

The relationship between these types of molecule
is illustrated below
 Sugar polymers – disaccharides and polysaccharides

Sugar units can

be joined
together by
condensation
reactions (i.e. a
bond is formed as
a result of the
elimination of a
water molecule)
e.g. two glucose
molecules joined by a This is called an a 1,4 glycosidic bond
because a-glucose
glycosidic bond bond between carbon 1 and carbon 4
to make maltose
Disaccharides
Polysaccharides

• Additional sugar units can be joined to either end of a disaccharide

molecule
• by condensation (as before)
• to produce a chain of sugar units
• called a polysaccharide

glycosidic bonds
poly-a-glucose
 Starch has two forms: Amylopectin
straight chain with branches at regular
Amylose intervals
Straight chain, no branches
Forms a coil glycosidic bond

a1,6
a1,4 bonds glucose glycosidic
molecule bond (also
formed by
condensation)
joins the
Molecule is branched to form a 3-D shape chains
together
chains of thousands of glucose molecules
Amylose

Amylopectin
• Glycogen is very similar in structure to amylopectin

long branched
chains of a-
glucose
Simple Carbohydrates Complex Carbohydrates
Digestible SIMPLE Carbohydrates Digestible COMPLEX Carbohydrates

Monosaccharides Examples Polysaccharides Examples

Starch and
Glucose Fruit, honey, corn syrup Grains, legumes & vegetables
dextrins
Fruit, juices, honey, high
Fructose Glycogen Meats
fructose corn syrup

Galactose Fruit, honey Partially Digested COMPLEX Carbohydrates

Jerusalem artichokes, onions,

Mannose Pineapple, olives, carrots Inulin
garlic

Disaccharides Mannosans Legumes

Sugar beets, kidney beans, lentils,

Sucrose Cane sugar, maple syrup Raffinose
navy beans

Lactose Milk and milk products Stachyose Dried beans

Malt products and some

Maltose Penthouses Fruits and gums
breakfast cereals
Indigestible COMPLEX carbohydrates (Dietary
Carbohydrate Derivatives
Fiber)

Ethyl alcohol Fermented grains Cellulose Vegetables and seeds

Lactic acid Milk products Hemicellulose Vegetables and seeds

Malic acid Fruits Pectins Citrus Fruits

Gums &
Oats, barley, seeds
mucilages
 Energy content of food

1 gram of protein
equals 4 kcal of energy

BUTTER
Energy
1 gram of fat
equals 9 kcal of energy

1 gram of carbohydrate
equals 4 kcal of energy
The human body is made to move in
many ways:
• Quick and powerful ‫ﺳرﯾﻌﺔ وﻗوﯾﺔ‬
• Graceful & coordinated ‫رﺷﯾﻘﺔ وﻣﻧﺳﻘﺔ‬
• Sustained for many hours ‫ﻣﺳﺗﻣرة ﻟﺳﺎﻋﺎت طوﯾﻠﺔ‬

And is dependent upon the capacity to produce energy

Cells in the body need energy to function

FOOD=ENERGY (E)
Cells don’t get Energy directly from
food, it must be broken down into:

ATP-Adensosine Triphosphate

ATP = a form of energy one can

immediately use, it is needed for cells
to function & muscles to contract
Nutrients that give us energy:

Carbohydrates Glucose
Fats Fatty acids
Digestion
Proteins Amino Acids

Absorbed into the blood & transported to cells

(muscle, liver & nerve)

They are used to produce ATP or stored

ATP is stored in small amounts, therefore
the rest is stored as:

•Glucose = Glycogen (muscle & liver)

•Fatty Acids = Body fat
•Amino Acids = Growth, repair or excreted
as waste
Carbohydrate Glucose:

ATP synthesis: all tissues

RBC, tissues of eye, renal medulla, brain, intestines, white blood cells,
skin
• Carbohydrate get converted to energy in the form of adenosine
triphosphate or ATP.

• It is from the energy released by the breakdown of ATP that allows

muscle cells to contract.
 ATP
• ATP is a chemical catabolized (i.e., broken down) from glucose and
stored as energy in the mitochondria of cells throughout the body.

• It is the necessary fuel for all body cells; without it, cells, and
therefore the body, cannot operate.
 ATP
The three main functions of ATP in cellular function are:

1. Transporting substances—such as sodium, calcium, potassium—

through the cell membrane.
2. Synthesizing ‫ ﺗوﻟﯾف‬chemical compounds, such as protein and
cholesterol.
3. Supplying energy for mechanical work, such as muscle contraction.
Predominant Energy Pathways

•Because the body can not easily store ATP (and what is
stored gets used up within a few seconds), it is
necessary to continually create ATP during exercise.

•In general, the two major ways the body converts

glucose to energy are:

Aerobic metabolism (with oxygen)

Anaerobic metabolism (without oxygen)
 Anaerobic Energy Pathway

• The ATP-CP energy pathway (sometimes called the

phosphate system) supplies about 10 seconds worth
of energy and is used for short bursts of exercise such
as a 100 meter sprint.

• This pathway doesn't require any oxygen to create

ATP. It first uses up any ATP stored in the muscle
(about 2-3 seconds worth) and then it uses creatine
phosphate (CP) to resynthesize ATP until the CP runs
out (another 6-8 seconds).
ATP-CP Energy System

ATP is stored in the muscle & liver for “Quick Energy”

• Nerve impulses trigger breakdown of ATP into ADP

• ATP = Adenosine Diphosphate & 1 Phosphate

The splitting of the Phosphate bond = Energy for work

Ex. Muscle Contraction (power the actin and myosin

filaments that lead to muscle contraction) , moving
hand from a hot stove, Jumping & throwing
 ATP-PC Energy System
ATP – Energy for muscle contraction
ATP-PC System
•ATP
•highest rate of energy production
•lowest total energy capacity
•all energy for muscle contraction
must flow through ATP
 The ATP Molecule
a. Adenosine Triphosphate (ATP)

Adenosine P
P
P

b. The breakdown of ATP:

Adenosine P
P P
Energy
Energy for cellular function

ATP = ADP + energy for biological work + P

(ADP = Adenosine Diphosphate)

For contractions to continue… ATP must be
REBUILT
This comes from the splitting of CP (Creatine
Phosphate a Hi energy source, automatic)

When ATP is used – it is rebuilt – as long as

there is CP
Energy released from CP breaking down,
resynthesizes the ADP & P
 The Immediate Resynthesis of ATP by CP
a. Creatine Phosphate (CP)

Creatine
High energy bond P

b. CP = Creatine + energy for resynthesis of ATP + P

Creatine P

Energy

c. ADP + energy from CP + P = ATP (reversal of ATP = ADP + P + energy for work)

Adenosine P
P
P
REMEMBER – only small amounts of ATP are
stored = only 2-3 sec. of Energy

ATP-CP = 8-10 sec. of Energy

The usefulness isn’t the AMOUNT of Energy

but the QUICK & POWERFUL movements

For longer periods of work = The

Aerobic & Anaerobic Energy System must be
utilized
ATP-PC System
•Phosphocreatine
•Rapid equilibrium with ATP/ADP
•Highest rate of energy production
•Lowest total energy production
 Anaerobic Energy Pathway

• After the ATP and CP are used the body will move on to either aerobic or
anaerobic metabolism (glycolysis) to continue to create ATP to fuel
exercise.
Anaerobic glycolysis

• It provides energy by the (partial) breakdown of

glucose without the need for oxygen.

• Anaerobic metabolism produces energy for short,

high-intensity bursts of activity lasting no more
than several minutes before the lactic acid build-
up reaches a threshold known as the lactate
threshold and muscle pain, burning and fatigue
make it difficult to maintain such intensity.
Anaerobic Respiration

anaerobic = in the absence of oxygen

In low oxygen conditions or during
heavy exercise, when not enough
oxygen can be supplied, muscle cells
swap to anaerobic respiration
Anaerobic Respiration

Stage 1 – Glycolysis

glyco lysis

glucose splitting
In glycolysis, a glucose molecule is broken down into
pyruvic acid.
glucose

energy released to series of enzyme

controlled reactions
make small quantity
of ATP
(2 molecules)

pyruvic acid

Glycolysis does not require oxygen

 glucose
glycolysis still
happens as it does
2 ADP + 2 Pi
not require oxygen
2 ATP

pyruvic acid
in absence of
oxygen pyruvic
acid is turned into
lactic acid.
lactic acid
A build up of lactic acid produces muscle fatigue.

Muscle fatigue makes muscles ache and contract less

powerfully.

A recovery period is needed. During this time more

oxygen is taken in to convert the lactic acid back into
pyruvic acid again.

The volume of oxygen needed is called the oxygen debt

(The amount of oxygen "owed" to the body in order to recover) .
 Summary
glucose

pyruvic acid
During hard oxygen debt
exercise repaid during
recovery time

lactic acid
This system can only be sustained for about 2-3 minutes (depending
on the individual) before severe fatigue sets in and you would have to
take time to recover.
Lactic Acid System
•Anaerobic glycolysis
•Uses muscle glycogen, blood glucose,
liver glycogen as substrates (not FAT or
PRO)
•High rate of ATP energy production
•Primary fuel in sprint-type activities (a
few seconds - few minutes)
Lactic Acid System
•Important when:
• Activity longer than a few seconds
• creatine-P depleted/limited
• Activity too intense for aerobic metabolism
• oxygen delivery limited
• limited rate of O2 :
• uptake in lung
• transport and delivery to muscle cell
• transport and delivery to mitochondria
Lactic Acid System
• Lactic acid is the end product
• Low total energy capacity
• lactic acidosis
• Inhibits glycolytic enzymes
• Training effects
• improved aerobic capacity reducing lactate production
• improved removal of lactate
 Aerobic metabolism
When exercise progresses beyond several minutes
• Aerobic metabolism fuels most of the energy needed
for long duration activity.

• It uses oxygen to convert glucose to ATP.

• This system is a bit slower than the anaerobic systems

because it relies on the circulatory system to transport
oxygen to the working muscles before it creates ATP.

• Aerobic metabolism is used primarily during endurance

exercise, which is generally less intense and can
continue for long periods of time.
• Muscle glycogen and blood glucose serve as the primary fuels
during intense anaerobic exercise beyond 10 seconds duration.

• Also glycogen stores play an important role in energy metabolism

in sustained high levels of aerobic exercise
Aerobic metabolism happens in 2
stages:

Stage 1 – Glycolysis

glyco lysis

glucose splitting
In glycolysis, a glucose molecule is broken down into
pyruvic acid.
glucose

energy released to series of enzyme

controlled reactions
make small quantity
of ATP
(2 molecules)

pyruvic acid

Glycolysis does not require oxygen

Stage 2 – Breakdown of pyruvic
acid

The pyruvic acid made in glycolysis (stage1) still contains a lot of

energy

It can only be broken down to release the rest of the energy in

the presence of oxygen.
 pyruvic acid

series of enzyme energy released

controlled to make large
reactions quantity of ATP
(36 molecules)

carbon dioxide + water

ATP production – summary
glucose

2 ADP + 2 Pi =
2 ATP

pyruvic acid

36 ADP + 36 Pi =
36 ATP

carbon dioxide + water

 Summary of ATP production

• Stage 1 and 2 release all the chemical energy in one molecule of

glucose to make a total of 38 ATP molecules.
2 molecules ATP from glucose ® pyruvic acid
36 molecules ATP from pyruvic acid ® carbon-
dioxide + water

Total 38 molecules ATP

Oxygen Energy System
 Oxygen Energy Systems
•Aerobic carbohydrate metabolism
• glycolysis, Krebs cycle, electron transport system
• lower rate of ATP energy production
• high total energy capacity
• primary source of energy for higher intensity endurance events (~<
30 min)
 09.06 Aerobic Respiration Overview
Slide number: 2

Glucose

Plasma
membrane Mitochondrion

Cytoplasm

Extracellular fluid

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 09.06 Aerobic Respiration Overview
Slide number: 4

Glucose Glycolysis Pyruvate

ATP
NADH
Acetyl-CoA
NADH

Plasma
membrane Mitochondrion

Cytoplasm

Extracellular fluid

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 09.06 Aerobic Respiration Overview
Slide number: 6

Glucose Glycolysis Pyruvate

ATP
NADH
Acetyl-CoA
NADH
H2O
Krebs ATP
cycle
NADH em
r t syst
t r a nspo
on
Plasma Electr
membrane Mitochondrion

Cytoplasm
ATP
Extracellular fluid

CO2 O2

Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 Oxygen Energy Systems
•Fat oxidation
• Beta-oxidation, Krebs cycle, Electron transport system
• Lowest rate of ATP-energy production
• Highest total energy capacity
• Primary source of energy during lower intensity endurance events
(~>30 min)
 Oxygen Energy Systems
•Protein oxidation
• Amino acid oxidation, Krebs cycle, Electron transport system
• Low rate of ATP-energy production
• Limited total energy capacity
• significant source of energy during long endurance events
Predominant Energy Pathways

•ATP (2-3 seconds)

•ATP-CP Energy System (8-10 seconds)
•Anaerobic Energy System (2-3 minutes)
•Aerobic Energy System (3 minutes +)
Human Energy Systems
•ATP-PC System
•adenosine triphosphate
•phosphocreatine
•Lactic Acid System
•anaerobic glycolytic pathway
•Oxygen System
•aerobic metabolic pathways
0 sec 4 sec 10 sec 1.5 min 3 min +

Strength – Power:
power lift, shot put ‫رﻣﻰ اﻟﺟﻠﺔ‬, golf
swing

Sustained Power:
sprints, fast breaks, football

Anaerobic Power – Endurance:

200-400 m dash, 100 m swim

Aerobic Endurance:
Beyond 800 m run

Immediate/short-term Aerobic-oxidative
non-oxidative systems system
 Examples
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and location.

Anaerobic 70-80% Anaerobic Aerobic

20-30% Aerobic

Wt. Training Stop & Go Sports Jogging

Gymnastics Tennis Marathons
Football Soccer Cycling
Baseball Field Hockey Aerobic Dance
 Human Energy Stores
Sources of energy for energy systems

•ATP-PC
•Carbohydrates
•Muscle glycogen
•Blood glucose
•Liver glycogen
 Human Energy Stores
•Fats - Triglycerides
• Adipose triglycerides
• Muscle triglyceride
• Hormone sensitive lipase
• Activity enhanced with caffeine
• Ketone bodies
• partially oxidized fatty acids
• produced in liver, burned in muscle
• significant source of energy during prolonged endurance
exercise
Human Energy Stores
•Proteins
•direct muscle oxidation
(branched chain amino acids)
•gluconeogenesis in liver from
amino acids
 Key Points:
Effect of Successive Days of Intense Training on Glycogen
Content

• Glycogen depletion can occur with successive days of intense training

• Even when individual training day is not glycogen depleting
• High carbohydrate diets promote replacement of glycogen used
during exercise
• Helps prevent glycogen depletion during successive days of training
 Metabolic Causes of Fatigue During Exercise.

• Decreased Levels of Energy Substrates

• decreased phosphocreatine levels
• decreased muscle glycogen
• decreased blood glucose
• Hypoglycemia
• decreased blood branch-chain amino acids
• Significant source of energy for muscle during endurance exercise
 Metabolic Causes of Fatigue During
Exercise.

•Disturbed Acid-Base Balance

• lactic acidosis

•Decreased Oxygen Transport

• decreased blood volume due to dehydration
• High altitudes
• Nutritional anemias
 Metabolic Causes of Fatigue During
Exercise.

•Increased Core Body Temperature

•dehydration
•environmental conditions
•Disturbed Electrolyte Balance
•high sweat loss
•no electrolyte replacement
Glucose from dietary carbohydrate: DIGESTION, ABSORPTION &
TRANSPORT into cells

DIGESTION
• Salivary glands:
Secrete amylase.
- digests starch.

• Stomach:
Secretes HCl.
- denatures protein and pepsin.

• Pancreas:
Secretes proteolytic enzymes and lipases.
- degrades proteins and fats.
• Liver and gallbladder:
Deliver bile salts.
- emulsify fat globules - easier to digest.

• Small intestine:
Further degradation.
Produces amino acids, hexose sugars, fatty acids
and glycerol.
Moves materials into blood for transport to cells.
• Carbohydrate: ABSORPTION
SITE OF ABSORPTION
Jejunum & Ileum

• CARBOHYDRATE TRANSPORT
- enterocyte to portal vein to liver

GLUCOSE UPTAKE INTO CELLS

- - stimulated by insulin (muscle, liver, adipocyte)
Factors affecting glucose concentration
Tend to raise Tend to lower
• Hunger • Satiety
• Glucose absorption from • Muscular exercise
gut • Insulin
• Hepatic glycogenolysis • ­ Glucose oxidation
• Adrenaline • ­ Glycogen deposition
• Glucagon • ­ Lipogenesis
• Gluconeogenesis in liver • ¯ Gluconeogenesis

• Insulin antagonist
• Growth Hormone
• Cortisol
• Insulin destroying enzymes
• Fate of glucose

glycogen synthesis ATP synthesis

GLUCOSE

NEAA synthesis FFA synthesis

 • Fate of glucose:
glycolysis, TCA cycle & FFA synthesis

glucose
ATP synthesis ATP

pyruvate lactate

acetyl-CoA FFA synthesis

oxaloacetic acid
(OAA) for
TCA cycle (citric acid cycle, tricarboxylic acid cycle or Krebs cycle)

gluconeogenesis ATP lots!!

• Fate of glucose: glycolysis & TCA cycle
purpose & tissues
glucose anaerobic glycolysis
- RBCs, WBCs
ATP
- kidney medulla
pyruvate lactate - enterocytes
- lens, cornea
- skin
- (skeletal muscle)
acetyl-CoA FFA

TCA cycle - make ATP (2 ATP/glucose)

- maintain blood glucose
• Fate of glucose: glycolysis & TCA cycle
purpose & tissues
glucose aerobic glycolysis
ATP - brain
- liver
pyruvate - skeletal muscle
- kidney cortex
- etc.
acetyl-CoA
- make ATP (38 ATP/glucose)
- maintain blood glucose
TCA cycle
ATP
• Fate of glucose: glycolysis & TCA cycle
stimulation and inhibition

glucose stimulation
ATP - high glucose
- low ATP
pyruvate lactate - insulin
inhibition
- high ATP
acetyl-CoA FFA
- FFAs

TCA cycle
ATP
• Fate of glucose: FFA synthesis
tissues, stimulation
(generally only occurs if excess calories eaten)
glucose mainly:
liver
adipocytes
pyruvate
diet stimulation
- high glucose
acetyl-CoA FFA - high ATP *
- insulin

TCA cycle TG
ATP
• Fate of glucose: NEAA synthesis
tissues, stimulation

glucose mainly:
liver
muscles
pyruvate
diet stimulation
- high glucose
acetyl-CoA NEAA - high ATP *
- insulin

TCA cycle Proteins

ATP
• Fate of glucose

glycogen synthesis ATP synthesis

glycolysis
TCA cycle
GLUCOSE

NEAA synthesis FFA synthesis

 • Fate of glucose: glycogen synthesis
Liver & Muscle
glucose glycogen

glycogen glycogen
glucose
gluc glucose
glucose
skeletal
muscle
Small Liver
Intestine
• Fate of glucose: glycogen synthesis
Liver & Muscle
glucose glycogen
stimulation: high glucose (liver)
insulin
low glycogen (muscle)

glycogen glycogen
glucose
gluc + ins + ins glucose
glucose
skeletal
muscle
SI Liver insulin
(ins)
pancreas
• Fate of glucose

glycogen synthesis ATP synthesis

GLUCOSE

NEAA synthesis FFA synthesis

glucose utilization
result: decrease blood glucose level
regulate tissue glucose use
• Glucose synthesis:

glycogen breakdown gluconeogenesis

GLUCOSE

glucose synthesis
purpose: - maintain blood glucose level:
fasting, sustained exercise, stress,
hypoglycaemia
- regulation of tissue glucose use
tissues: liver, muscle, kidney
Citric Acid Cycle