DIGESTION, ABSORPTION AND TRANSPORT OF SUGARS

Whenever we eat something, not only are we eating a delicious snack or meal, we are also ingesting the
molecular compounds and elements that make up those foods. As our food makes its way through our bodies it
goes through a series of changes so we are able to digest it more effectively and extract the nutrients and fuel
needed to nourish the cells of the body.
Many of the foods we eat contain carbohydrates - which includes both sugars and starches, and our bodies will
metabolize them in three main ways:-
1. digestion,
2. absorption, and
3. transportation
When our body metabolizes carbohydrates it results in the production of glucose molecules which are the most
efficient source of energy for our muscles and our brains. Everything we eat contributes to cell growth, repair
and normal cell functioning, or if too much food (energy) is consumed, we store this excess in various places
throughout our bodies.

At the end of the lesson, students should be able to:

 Discuss how carbohydrates are digested and absorbed in the human body.
 Differentiate between chemical and mechanical digestion.
 Identify the locations and primary secretions involved in the chemical digestion of carbohydrates

 Compare and contrast absorption of the different nutrients

 Describe blood glucose regulation.


WHICH CARBOHYDRATES ARE BROKEN DOWN BY THE BODY?

When we eat food it is typically made up of many different nutrients and elements that when combined can
make up a healthy meal. Most of the food and drink we eat can be broken down into three major parts –proteins,
fats and carbohydrates. The others are – vitamins, minerals and water.
What are Polysaccharides? (eg. starch, fibre or cellulose)

Foods that contain polysaccharides can be broken into three main groups or types of foods:-
 Foods that contain starch or ‘starchy carbohydrates’ like potatoes, corn and rice. Foods that contain fibre
like split peas, chickpeas, beans and lentils.
 Foods that contain cellulose like fruits and vegetables (including the skin of apples and pears), wheat
bran and spinach.
What are Disaccharides? (eg. lactose, maltose, sucrose)
Foods that contain disaccharides can be broken into three main groups or types of foods:-
 Foods that contain lactose like dairy products (milk, cheese, yoghurt, etc), chocolate and soft-serve ice
cream.
 Foods that contain maltose like grains and wheats (wheat, cornmeal, some ancient grains and sweet
potatoes etc).
 Foods that contain sucrose like soft drinks, cookies, cakes, some fruits (tangerines for example) and
sugary cereals.
What are Monosaccharide? (eg. glucose, galactose, fructose)
 Foods that contain glucose like grapes, dried apricots, honey and soft drinks.
 Foods that contain galactose like celery, beetroot, basil, spinach, kiwi fruit and plums.
 Foods that contain fructose like most fruit, soft drinks, sports drinks, cakes, confectionery and chocolate.

CARBOHYDRATES ARE MADE FROM BUILDING BLOCKS CALLED SIMPLE SUGARS OR

MONOSACCHARIDES
When two building blocks or monosaccharides join together they form a disaccharide. The most common
disaccharide that we are all familiar with is what we know as sucrose or table sugar.
Apart from sugars, other types of carbohydrates are made up of long chains of monosaccharides or
disaccharides, all joined together in different combinations – that can often be very complex – these are called
polysaccharides. They usually contain from 10 up to several thousand monosaccharides arranged in chains.
The main types of polysaccharides you have probably heard of already are: Starch, cellulose, pectin, gums and
fibre.

Simple Sugars/Monosaccharides
There are three main monosaccharides that combine to form many of the different types of sugars or
disaccharides found naturally in foods.
Glucose – this is one of the most important forms of sugar used by the body for energy. All other carbohydrates
(including other sugars) are converted into glucose during the digestion of food. Glucose is naturally found in
some fruits and vegetables and the nectar or sap of plants.
Fructose – is also known as fruit sugar, and is the main sugar found in fruits, berries, honey, root vegetables
and some grains.
Galactose – this monosaccharide is mostly found in milk and yoghurt.

Simple Sugars/Disaccharides
Sucrose – this is the most common form of sugar and is usually obtained from sugar cane or sugar beet. It can
also be found in some fruits and vegetables.
Sucrose = 1 Glucose + 1 Fructose
Lactose – this is what we normally call milk sugar, because it is found in all mammals' milk and dairy products.
Lactose = 1 Glucose + 1 Galactose
Maltose – is found in germinating grains such as barley, as well as in malt or malted foods and beverages. It is
often called malt sugar
Maltose = 1 Glucose + 1 Glucose

Other Carbohydrates/ Complex Carbohydrates: Three or more sugars (oligosaccharides or polysaccharides)

bonded together in a more complex chemical structure. These take longer to digest and therefore have a more
gradual effect on the increase in blood sugar. Examples: cellobiose, rutinulose, amylose, cellulose, dextrin
Foods: apples, broccoli, lentils, spinach, unrefined whole grains, brown rice
Starch – is probably the most common of the polysaccharides and it is made up of long chains of glucose.
Starch is made by plants during photosynthesis. It is present in cereal grains [wheat, oats, rye, barley,
buckwheat, rice etc] potatoes and legumes [beans, peas, lentils].
Fibre: -- Non-digestible complex carbohydrates that encourage healthy bacterial growth in the colon and act as
a bulking agent, easing defaecation. The main components include cellulose, hemicellulose, and pectin.
  Insoluble: Remains in the intestines, thereby softening and bulking the stool. Benefits include
regularity of bowel movements and a decreased risk of diverticulosis. Examples: brans, seeds,
vegetables, brown rice, and potato skins.
o Soluble: Helps decrease blood cholesterol and LDL levels, reduces straining with defecation,
and blunts postprandial blood glucose levels. Examples are fleshy fruit, oats, broccoli, and dried
beans.
Cellulose – is another long chain polysaccharide made from many glucose building blocks. We often talk about
cellulose as dietary fibre or what we used to call "roughage" as the human body is unable to break it down
during digestion.
Pectin – is a type of fibre, found mainly in plant walls, which gives fruit its structure and firmness. If you've
ever tried to make jam or fruit jelly you will know about pectin! Pectin is found naturally in fruit and
vegetables, but in varying amounts, which is why some jams set without added pectin and others do not. Fruits
high in pectin include apples and most citrus fruits. Lower amounts are found in berries, stone fruits, figs and
rhubarb.
Gums - ever wondered what agar agar, guar gum or xanthan gum are? You may see these written on some food
labels. Well they are what we call vegetable gums that are also polysaccharides and they are used primarily as
thickeners in food. Some seaweeds are also excellent sources of gums and are commonly called carrageenan
and alginates. They are often used as a vegetable substitute for gelatin.
Glycogen – is the stored from of glucose in the human body. The body stores enough glycogen in the liver,
muscles and brain to last for 24 hours.

DIGESTION OF CARBOHYDRATES
When we eat foods that contain carbohydrates the body needs to break these down into simple monosaccharides
for the body to use.
The digestion process of polysaccharides such as starch will begin in the mouth where it is broken down or
'hydrolysed' by salivary amylase (an enzyme in your saliva that helps to break down starches). The amount of
starch hydrolysed in your mouth is often quite small as most food doesn’t stay in your mouth for very long.
Once you've swallowed your carbohydrate food and it reaches the stomach the salivary enzymes that help with
digestion are either altered or destroyed so won’t work as effectively. As a result, digestion predominantly
occurs in the small intestine with another enzyme, pancreatic amylase, transforming or breaking down
(technically hydrolyzing) the starch to more manageable molecules of dextrin and maltose.
Further to this, enzymes classed as glucosidases on the brush border wall of the small intestine (a section of the
small intestine that helps with the absorption of the digested nutrients) break down the dextrin to maltose and
then further onto glucose. The other disaccharides are broken down and converted into their two
monosaccharide units.
Mechanical digestion involves physical movement to make foods smaller. Chemical digestion uses enzymes to
break down food.

Mechanical Digestion
The process of mechanical digestion is relatively simple. It involves the physical breakdown of food but does
not alter its chemical makeup. Mechanical digestion begins in the mouth with chewing, then moves to churning
in the stomach and segmentation in the small intestine. Peristalsis is also part of mechanical digestion. This
refers to involuntary contractions and relaxations of the muscles of the esophagus, stomach, and intestines to
break down food and move it through the digestive system.
 Fig. 1: Digestion and Absorption Digestion begins in the mouth and continues as food travels through the small intestine. Most
absorption occurs in the small intestine.

Chemical Digestion
Chemical digestion, on the other hand, is a complex process that reduces food into its chemical building blocks,
which are then absorbed to nourish the cells of the body (Figure 1). Large food molecules (for example,
proteins, lipids, nucleic acids, and starches) must be broken down into subunits that are small enough to be
absorbed by the lining of the alimentary canal. This is accomplished by enzymes through hydrolysis. The many
enzymes involved in chemical digestion are summarized in Table 1. Chemical digestion involves the secretions
of enzymes throughout the digestive tract. These enzymes break the chemical bonds that hold food particles
together. This allows food to be broken down into small, digestible parts.

Table 1: The Digestive Enzymes

Enzyme Enzyme
Category Name Source Substrate Product

Salivary Salivary
Salivary glands Polysaccharides Disaccharides and trisaccharides
Enzymes amylase

Brush border
α-Dextrinase Small intestine α-Dextrins Glucose
enzymes

Brush border
Lactase Small intestine Lactose Glucose and galactose
enzymes

Brush border
Maltase Small intestine Maltose Glucose
enzymes

Brush border
Sucrase Small intestine Sucrose Glucose and fructose
enzymes
Enzyme Enzyme
Category Name Source Substrate Product

Pancreatic Pancreatic Pancreatic Polysaccharides α-Dextrins, disaccharides (maltose),

enzymes amylase acinar cells (starches) trisaccharides (maltotriose)

Table 1 *These enzymes have been activated by other substances.

Carbohydrate Digestion
The average diet is about 50 percent carbohydrates, which may be classified according to the number of
monomers they contain of simple sugars (monosaccharides and disaccharides) and/or complex sugars
(polysaccharides). Glucose, galactose, and fructose are the three monosaccharides that are commonly consumed
and are readily absorbed. Your digestive system is also able to break down the disaccharide sucrose (regular
table sugar: glucose + fructose), lactose (milk sugar: glucose + galactose), and maltose (grain sugar: glucose +
glucose), and the polysaccharides glycogen and starch (chains of monosaccharides). Your bodies do not
produce enzymes that can break down most fibrous polysaccharides, such as cellulose. While indigestible
polysaccharides do not provide any nutritional value, they do provide dietary fiber, which helps propel food
through the alimentary canal.
From the Mouth to the Stomach
The mechanical and chemical digestion of carbohydrates begins in the mouth. Chewing, also known as
mastication, crumbles the carbohydrate foods into smaller and smaller pieces. The salivary glands in the oral
cavity secrete saliva that coats the food particles. Saliva contains the enzyme, salivary amylase. This enzyme
breaks the bonds between the monomeric sugar units of disaccharides, oligosaccharides, and starches. The
salivary amylase breaks down amylose and amylopectin into smaller chains of glucose, called dextrins and
maltose. The increased concentration of maltose in the mouth that results from the mechanical and chemical
breakdown of starches in whole grains is what enhances their sweetness. Only about five percent of starches are
broken down in the mouth. (This is a good thing as more glucose in the mouth would lead to more tooth decay.)
When carbohydrates reach the stomach no further chemical breakdown occurs because the amylase enzyme
does not function in the acidic conditions of the stomach. But mechanical breakdown is ongoing—the strong
peristaltic contractions of the stomach mix the carbohydrates into the more uniform mixture of chyme.
From the Stomach to the Small Intestine
The chyme is gradually expelled into the upper part of the small intestine. Upon entry of the chyme into the
small intestine, the pancreas releases pancreatic juice through a duct. This pancreatic juice contains the enzyme,
pancreatic amylase, which starts again the breakdown of dextrins into shorter and shorter carbohydrate chains.
Additionally, enzymes are secreted by the intestinal cells that line the villi. These enzymes, known collectively
as disaccharidase, are sucrase, maltase, and lactase. Sucrase breaks sucrose into glucose and fructose molecules.
Maltase breaks the bond between the two glucose units of maltose, and lactase breaks the bond between
galactose and glucose. Once carbohydrates are chemically broken down into single sugar units they are then
transported into the inside of intestinal cells.
In the small intestine, pancreatic amylase does the ‘heavy lifting’ for starch and carbohydrate digestion (Figure
1). After amylases break down starch into smaller fragments, the brush border enzyme α-dextrinase starts
working on α-dextrin, breaking off one glucose unit at a time. Three brush border enzymes hydrolyze sucrose,
lactose, and maltose into monosaccharides. Sucrase splits sucrose into one molecule of fructose and one
molecule of glucose; maltase breaks down maltose and maltotriose into two and three glucose molecules,
respectively; and lactase breaks down lactose into one molecule of glucose and one molecule of galactose.
When people do not have enough of the enzyme lactase, lactose is not sufficiently broken down resulting in a
condition called lactose intolerance. The undigested lactose moves to the large intestine where bacteria are able
to digest it. The bacterial digestion of lactose produces gases leading to symptoms of diarrhea, bloating, and
abdominal cramps. Lactose intolerance usually occurs in adults and is associated with race.

Figure 2 Carbohydrate Digestion Flow Chart Carbohydrates are broken down into their monomers in a series of steps.
Absorption: Going to the Blood Stream
The cells in the small intestine have membranes that contain many transport proteins in order to get the
monosaccharides and other nutrients into the blood where they can be distributed to the rest of the body. The
first organ to receive glucose, fructose, and galactose is the liver. The liver takes them up and converts galactose
to glucose, breaks fructose into even smaller carbon-containing units, and either stores glucose as glycogen or
exports it back to the blood. How much glucose the liver exports to the blood is under hormonal control and you
will soon discover that even the glucose itself regulates its concentrations in the blood.
 Figure : Carbohydrate Digestion. Carbohydrate digestion begins in the mouth and is most extensive in the small
intestine. The resultant monosaccharides are absorbed into the bloodstream and transported to the liver.
Maintaining Blood Glucose Levels: The Pancreas and Liver
Glucose levels in the blood are tightly controlled, as having either too much or too little glucose in the blood
can have health consequences. Glucose regulates its levels in the blood via a process called negative feedback.
An everyday example of negative feedback is in your oven because it contains a thermostat. When you set the
temperature to cook a delicious homemade noodle casserole at 375°F the thermostat senses the temperature and
sends an electrical signal to turn the elements on and heat up the oven. When the temperature reaches 375°F the
thermostat senses the temperature and sends a signal to turn the element off. Similarly, your body senses blood
glucose levels and maintains the glucose “temperature” in the target range. The glucose thermostat is located
within the cells of the pancreas. After eating a meal containing carbohydrates glucose levels rise in the blood.
Insulin-secreting cells in the pancreas sense the increase in blood glucose and release the hormone, insulin, into
the blood. Insulin sends a signal to the body’s cells to remove glucose from the blood by transporting it into
different organ cells around the body and using it to make energy. In the case of muscle tissue and the liver,
insulin sends the biological message to store glucose away as glycogen. The presence of insulin in the blood
signifies to the body that glucose is available for fuel. As glucose is transported into the cells around the body,
the blood glucose levels decrease. Insulin has an opposing hormone called glucagon. Glucagon-secreting cells
in the pancreas sense the drop in glucose and, in response, release glucagon into the blood. Glucagon
communicates to the cells in the body to stop using all the glucose. More specifically, it signals the liver to
break down glycogen and release the stored glucose into the blood, so that glucose levels stay within the target
range and all cells get the needed fuel to function properly.
 The Regulation of Glucose
Leftover Carbohydrates: The Large Intestine
Almost all of the carbohydrates, except for dietary fiber and resistant starches, are efficiently digested and
absorbed into the body. Some of the remaining indigestible carbohydrates are broken down by enzymes
released by bacteria in the large intestine. The products of bacterial digestion of these slow-releasing
carbohydrates are short-chain fatty acids and some gases. The short-chain fatty acids are either used by the
bacteria to make energy and grow, are eliminated in the feces, or are absorbed into cells of the colon, with a
small amount being transported to the liver. Colonic cells use the short-chain fatty acids to support some of their
functions. The liver can also metabolize the short-chain fatty acids into cellular energy. The yield of energy
from dietary fiber is about 2 kilocalories per gram for humans, but is highly dependent upon the fiber type, with
soluble fibers and resistant starches yielding more energy than insoluble fibers. Since dietary fiber is digested
much less in the gastrointestinal tract than other carbohydrate types (simple sugars, many starches) the rise in
blood glucose after eating them is less, and slower. These physiological attributes of high-fiber foods (i.e. whole
grains) are linked to a decrease in weight gain and reduced risk of chronic diseases, such as Type 2 diabetes and
cardiovascular disease.

Overview of Carbohydrate Digestion

A Carbohydrate Feast
You are at a your grandma’s house for family dinner and you just consumed kalua pig, white rice, sweet
potatoes, mac salad, chicken long rice and a hot sweet bread roll dripping with butter. Less than an hour later
you top it off with a slice of haupia pie and then lie down on the couch to watch TV. The “hormone of plenty,”
insulin, answers the nutrient call. Insulin sends out the physiological message that glucose is abundant in the
blood, so that cells can absorb it and either use it or store it. The result of this hormone message is maximization
of glycogen stores and all the excess glucose, protein, and lipids are stored as fat.

A typical American Thanksgiving meal contains many foods that are dense in carbohydrates, with the majority
of those being simple sugars and starches. These types of carbohydrate foods are rapidly digested and absorbed.
Blood glucose levels rise quickly causing a spike in insulin levels. Contrastingly, foods containing high
amounts of fiber are like time-release capsules of sugar. A measurement of the effects of a carbohydrate-
containing food on blood-glucose levels is called the glycemic response.

Glycemic Index
The glycemic responses of various foods have been measured and then ranked in comparison to a reference
food, usually a slice of white bread or just straight glucose, to create a numeric value called the glycemic index
(GI). Foods that have a low GI do not raise blood-glucose levels neither as much nor as fast as foods that have a
higher GI. A diet of low-GI foods has been shown in epidemiological and clinical trial studies to increase
weight loss and reduce the risk of obesity, Type 2 diabetes, and cardiovascular disease.
For the Glycemic Index on different foods, visit http://www.mendosa.com/gilists.htm.

The type of carbohydrate within a food affects the GI along with its fat and fiber content. Increased fat and fiber
in foods increases the time required for digestion and delays the rate of gastric emptying into the small intestine
which, ultimately reduces the GI. Processing and cooking also affects a food’s GI by increasing their
digestibility. Advancements in the technologies of food processing and the high consumer demand for
convenient, precooked foods in the United States has created foods that are digested and absorbed more rapidly,
independent of the fiber content. Modern breakfast cereals, breads, pastas, and many prepared foods have a high
GI. In contrast, most raw foods have a lower GI. (However, the more ripened a fruit or vegetable is, the higher
its GI.)
The GI can be used as a guide for choosing healthier carbohydrate choices but has some limitations. The first is
GI does not take into account the amount of carbohydrates in a portion of food, only the type of carbohydrate.
Another is that combining low- and high-GI foods changes the GI for the meal. Also, some nutrient-dense foods
have higher GIs than less nutritious food. (For instance, oatmeal has a higher GI than chocolate because the fat
content of chocolate is higher.) Lastly, meats and fats do not have a GI since they do not contain carbohydrates.

Absorption can occur through five mechanisms: (1) active transport, (2) passive diffusion, (3) facilitated
diffusion, (4) co-transport (or secondary active transport), and (5) endocytosis. As you will recall, active
transport refers to the movement of a substance across a cell membrane going from an area of lower
concentration to an area of higher concentration (up the concentration gradient). In this type of transport,
proteins within the cell membrane act as “pumps,” using cellular energy (ATP) to move the substance. Passive
diffusion refers to the movement of substances from an area of higher concentration to an area of lower
concentration, while facilitated diffusion refers to the movement of substances from an area of higher to an area
of lower concentration using a carrier protein in the cell membrane. Co-transport uses the movement of one
molecule through the membrane from higher to lower concentration to power the movement of another from
lower to higher. Finally, endocytosis is a transportation process in which the cell membrane engulfs material. It
requires energy, generally in the form of ATP.
Because the cell’s plasma membrane is made up of hydrophobic phospholipids, water-soluble nutrients must
use transport molecules embedded in the membrane to enter cells. Moreover, substances cannot pass between
the epithelial cells of the intestinal mucosa because these cells are bound together by tight junctions. Thus,
substances can only enter blood capillaries by passing through the apical surfaces of epithelial cells and into the
interstitial fluid. Water-soluble nutrients enter the capillary blood in the villi and travel to the liver via the
hepatic portal vein.
In contrast to the water-soluble nutrients, lipid-soluble nutrients can diffuse through the plasma membrane.
Once inside the cell, they are packaged for transport via the base of the cell and then enter the lacteals of the
villi to be transported by lymphatic vessels to the systemic circulation via the thoracic duct. The absorption of
most nutrients through the mucosa of the intestinal villi requires active transport fueled by ATP. The routes of
absorption for each food category are summarized below.
Absorption in the Alimentary Canal

Breakdown Absorption Entry to

Food products mechanism bloodstream Destination

Co-transport with Capillary blood Liver via hepatic

Carbohydrates Glucose
sodium ions in villi portal vein

Co-transport with Capillary blood Liver via hepatic

Carbohydrates Galactose
sodium ions in villi portal vein

Facilitated Capillary blood Liver via hepatic

Carbohydrates Fructose
diffusion in villi portal vein

ABSORBTION AND TRANSPORTION OF BROKEN-DOWN CARBOHYDRATES IN THE BODY

The monosaccharide units, glucose, galactose and fructose are transported through the wall of the small
intestine and then into the portal vein which then takes these elements straight to the liver. The mode of
transport varies between the three monosaccharides.
Both glucose and fructose are absorbed relatively quickly, depending on what other nutrients are eaten at the
same time. For example, a meal or food containing protein and fat causes the sugars to be absorbed more slowly
than when consumed on their own.
 Glucose, at low concentrations, is transported through the mucosal lining into the epithelial cells of the
intestine by active transport, via a sodium-dependent transporter. At higher concentrations, a second
facilitative transporter becomes involved. From the epithelial cells, glucose is moved into the
surrounding capillaries by facilitated diffusion.
 Galactose is transported in the same way as glucose, utilising the same transporters. As galactose is not
found as a monosaccharide in nature, absorbed galactose primarily comes from the breakdown of
lactose.
 Fructose moves entirely via facilitated diffusion. The process utilises a different transporter to glucose
when entering the enterocytes, however, both fructose and glucose utilise the same transporter to exit the
enterocyte into the capillaries. The absorption of fructose is much slower than that of glucose and is
quantitatively limited.
Consumption of large amounts of fructose has been shown to produce a level of fructose malabsorption in
almost all cases. Co-ingestion of glucose with fructose has been shown to facilitate fructose absorption. The
exact mechanisms for this are still under scientific research.
Once in the liver galactose and fructose are removed from the blood and converted into other metabolites. When
eaten in moderate quantities, most fructose is taken up by the liver and converted to glucose, glycogen and
lactate. A fraction of these elements may also be oxidised or converted into fatty acids and uric acid.
Only a small amount of fructose reaches the bloodstream, so blood fructose concentrations are typically always
low. Galactose is primarily converted into glucose and stored as glycogen.
On the other hand, most of the glucose derived from food is transported via the bloodstream to the peripheral
tissues where, under normal circumstances, the hormone insulin enables it to be taken up by the cells and used
as an energy source via a metabolic pathway known as the ‘glycolysis pathway’.
As glucose is the most important fuel source for the body and in particular the brain, the body attempts to keep a
basal circulating blood glucose of around 4-5mmol/L. This homeostasis mechanism is predominantly controlled
by the actions of glycogen and insulin.

How does the body store excess energy?

Surplus glucose is initially stored as glycogen in the liver or muscles. The liver can store approximately 100g of
glycogen which is then used to maintain basal blood glucose levels between meals, whilst the muscles typically
store 400-500g often used during movement.
Once these reserves hit a peak or are saturated, excess glucose is converted to fat for longer-term storage.
Consuming more energy than we need from any of these sources results in the storage of excess energy as body
fat.
Whilst our bodies need energy from carbohydrates, fats and proteins for normal functioning, it is important to
consider the energy we get from all sources so we can achieve a balanced diet.

Exceptions
The most notable exception to the carbohydrate metabolism explained above is dietary fibre. Dietary fibre – a
type of polysaccharide, can be classed as either soluble (dissolves in water) or insoluble (cannot be dissolved in
water).
The body cannot digest or absorb dietary fibre like other carbohydrates. Instead, a portion is fermented by
colonic gut bacteria. As a result, it passes relatively untouched through the digestive system and is removed in
stools.

MEDICAL CONDITIONS THAT AFFECT HOW CARBOHYDRATES ARE DIGESTED

There are some medical conditions that may interrupt the process of digesting carbohydrates. The following list
is not exhaustive and these conditions are usually rare and genetic, meaning they’re inherited at birth.

Galactosemia
Galactosemia is a genetic disorder that affects how the body processes the simple sugar galactose, a sugar that is
part of a larger sugar called lactose that’s found in milk, cheese, and other dairy products. It leads to having too
much of this sugar in the blood, causing complications like liver damage, learning disabilities, or reproductive
issues.

Fructose malabsorption
This condition has also been called dietary fructose intolerance. It affects how the body breaks down the sugar
fructose from fruits and vegetables, honey, agave, and processed foods. Symptoms include:
 nausea
 diarrhea
 chronic fatigue
Mucopolysaccharidoses
Hunter syndrome is a type of inherited disorder classified under mucopolysaccharidoses (MPSs).
It typically begins between the ages of 2 and 4 years old and is caused by a missing enzyme that doesn’t break
down carbohydrates. Physical abilities, appearance, mental development, and organ function may all be
impacted by this disorder.

Pyruvate metabolism disorders

Pyruvate dehydrogenase deficiency is a type of inherited disorder classified under pyruvate metabolism
disorders. It causes a buildup of lactic acid in the bloodstream.
Symptoms may begin as early as infancy. They include:
 lethargy
 poor feeding
 rapid breathing
 poor muscle tone
 abnormal eye movements
Symptoms can appear worse after carbohydrate-heavy meals.