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Chapter: Medical Physiology: Digestion and Absorption in the Gastrointestinal Tract

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Absorption of Nutrients in the Small Intestine

Essentially all the carbohydrates in the food are absorbed in the form of monosaccharides; only a small fraction are absorbed as disaccharides and almost none as larger carbohydrate compounds.

Absorption of Nutrients

Absorption of Carbohydrates

Essentially all the carbohydrates in the food are absorbed in the form of monosaccharides; only a small fraction are absorbed as disaccharides and almost none as larger carbohydrate compounds. By far the most abundant of the absorbed monosaccharides is glucose, usually accounting for more than 80 per cent of carbohydrate calories absorbed. The reason for this is that glucose is the final digestion product of our most abundant carbohydrate food, the starches. The remaining 20 per cent of absorbed monosaccharides are composed almost entirely of galactose and fruc-tose, the galactose derived from milk and the fructoseas one of the monosaccharides digested from cane sugar.

Virtually all the monosaccharides are absorbed by an active transport process. Let us first discuss the absorption of glucose.

Glucose Is Transported by a Sodium Co-Transport Mechanism.

In the absence of sodium transport through the intes-tinal membrane, virtually no glucose can be absorbed. The reason is that glucose absorption occurs in a co-transport mode with active transport of sodium.

There are two stages in the transport of sodium through the intestinal membrane. First is active trans-port of sodium ions through the basolateral mem-branes of the intestinal epithelial cells into the blood, thereby depleting sodium inside the epithelial cells. Second, decrease of sodium inside the cells causes sodium from the intestinal lumen to move through the brush border of the epithelial cells to the cell interiors by a process of facilitated diffusion. That is, a sodium ion combines with a transport protein, but the trans-port protein will not transport the sodium to the inte-rior of the cell until the protein itself also combines with some other appropriate substance such as glucose. Fortunately, intestinal glucose also combines simultaneously with the same transport protein, and then both the sodium ion and glucose molecule are transported together to the interior of the cell. Thus, the low concentration of sodium inside the cell liter-ally “drags” sodium to the interior of the cell and along with it the glucose at the same time. Once inside the epithelial cell, other transport proteins and enzymes cause facilitated diffusion of the glucose through the cell’s basolateral membrane into the paracellular space and from there into the blood.

To summarize, it is the initial active transport of sodium through the basolateral membranes of the intestinal epithelial cells that provides the eventual motive force for moving glucose also through the membranes.

Absorption of Other Monosaccharides. Galactose is trans-ported by almost exactly the same mechanism as glucose. Conversely, fructose transport does not occur by the sodium co-transport mechanism. Instead, fruc-tose is transported by facilitated diffusion all the way through the intestinal epithelium but not coupled with sodium transport.

Much of the fructose, on entering the cell, becomes phosphorylated, then converted to glucose, and finally transported in the form of glucose the rest of the way into the blood. Because fructose is not co-transported with sodium, its overall rate of transport is only about one half that of glucose or galactose.

Absorption of Proteins

Most proteins, after digestion, are absorbed through the luminal membranes of the intestinal epithelial cells in the form of dipeptides, tripeptides, and a few free amino acids. The energy for most of this transport is supplied by a sodium co-transport mechanism in the same way that sodium co-transport of glucose occurs. That is, most peptide or amino acid molecules bind in the cell’s microvillus membrane with a specific transport protein that requires sodium binding before transport can occur. After binding, the sodium ion then moves down its electrochemical gradient to the interior of the cell and pulls the amino acid or peptide along with it. This is called co-transport (or secondary active transport) of the amino acids and peptides. A few amino acids donot require this sodium co-transport mechanism but instead are transported by special membrane trans-port proteins in the same way that fructose is trans-ported, by facilitated diffusion.

At least five types of transport proteins for trans-porting amino acids and peptides have been found in the luminal membranes of intestinal epithelial cells. This multiplicity of transport proteins is required because of the diverse binding properties of different amino acids and peptides.

Absorption of Fats

Earlier, it was pointed out that when fats are digested to form monoglycerides and free fatty acids, both of these digestive end products first become dissolved in the central lipid portions of bile micelles. Because the molecular dimensions of these micelles are only 3 to 6 nanometers in diameter, and because of their highly charged exterior, they are soluble in chyme. In this form, the monoglycerides and free fatty acids are carried to the surfaces of the microvilli of the intestinal cell brush border and then penetrate into the recesses among the moving, agitating microvilli. Here, both the monoglycerides and fatty acids diffuse imme-diately out of the micelles and into the interior of the epithelial cells, which is possible because the lipids are also soluble in the epithelial cell membrane. This leaves the bile micelles still in the chyme, where they function again and again to help absorb still more monoglycerides and fatty acids.

Thus, the micelles perform a “ferrying” function that is highly important for fat absorption. In the presence of an abundance of bile micelles, about 97 per cent of the fat is absorbed; in the absence of the bile micelles, only 40 to 50 per cent can be absorbed.

After entering the epithelial cell, the fatty acids and monoglycerides are taken up by the cell’s smooth endoplasmic reticulum; here, they are mainly used to form new triglycerides that are subsequently released in the form of chylomicrons through the base of the epithelial cell, to flow upward through the thoracic lymph duct and empty into the circulating blood.

Direct Absorption of Fatty Acids into the Portal Blood. Smallquantities of short- and medium-chain fatty acids, such as those from butterfat, are absorbed directly into the portal blood rather than being converted into triglyc-erides and absorbed by way of the lymphatics. The cause of this difference between short- and long-chain fatty acid absorption is that the short-chain fatty acids are more water-soluble and mostly are not recon-verted into triglycerides by the endoplasmic reticulum. This allows direct diffusion of these short-chain fatty acids from the intestinal epithelial cells directly into the capillary blood of the intestinal villi.


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