Health benefits of resistant starch

SHALINI K. GHODKE, LAXMI ANANTHANARAYAN*

*Corresponding author
Food Engineering and Technology Department
Institute of Chemical Technology, University of Mumbai
Matunga, Mumbai 400 019, India

ABSTRACT: Resistant starches (RS) have drawn broad interest worldwide for both their potential health benefits and functional
properties. Initial clinical studies demonstrate that resistant starches have properties similar to fiber and show promising physiological
benefits in humans, which may result in prevention of various diseases. The present review highlights a number of these aspects and
describes the metabolic and functional properties of RS such as attenuating blood glucose, maintaining gastrointestinal health, acting as
prebiotic, helping in beneficial lipid metabolism and assisting weight loss.

INTRODUCTION

Natural, wholesome and health promoting food is the current demand

of health conscious consumers. Due to altered life style, diet has
become rich in fat, carbohydrates and animal protein and low in
dietary fiber. Consequently, constipation, obesity, type II diabetes,
cancer, heart diseases and many other diseases are on the rise. A
recent US survey showed functional ingredients such as dietary fiber
to be viewed positively by consumers as ranking high amongst
Starch

functional ingredients (1). The World Health Organization currently

recommends consumption of >25 grams of total dietary fiber/day. In
fact, the WHO has identified dietary fiber as the only dietary
ingredient with "Convincing Evidence" showing a protective effect
against weight gain and obesity (2). Resistant starch (RS) is one of
the best sources of fiber available in diet. This review focuses on
health benefits of RS in the diet.
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HEALTH BENEFITS

TYPES OF RESISTANT STARCH
Starch is composed primarily of two polysaccharides - a linear
amylose containing α-1-4 glycosidic bonds and branched amylopectin
in which branching occurs through α-1-6 linkages on the amylose
chains. The amount of amylose present in starch varies from 17-38
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There is ample justification that RS behaves physiologically like fiber.
RS assays as insoluble fiber and has the physiological benefits of
soluble fiber. Numerous studies in rats (8-11) have shown RS to
escape digestion in the small intestine and be slowly fermented in the
large intestine. Following are some of the metabolic health benefits of
RS.

percent and depends on the botanical origin. The way in which these
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polymers pack themselves in their granular and non granular (after

processing) forms makes a starch resistant to enzymatic digestion in BLOOD GLUCOSE AND INSULIN RESPONSE
the intestine (3). RS is resistant to enzymatic digestion by α-amylase
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and has been defined as "the sum of starch and products of starch Insulin is a hormone that enables glucose uptake by muscle and
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degradation not absorbed in the small intestine of healthy individuals".
RS is classified as a part of dietary fiber when measured using AACC
Approved Methods 32-07 (4) and AOAC Method 991.43 (5). Over the
last decade, there has been increased interest in the nutritional
implications of RS because of their low calorie content and
physiological effects similar to dietary fiber. RS that reaches the large
intestine acts as a substrate for microbial fermentation, the end-
products being hydrogen, carbon dioxide, methane and short chain
fatty acids (SCFA) (6). There are four types of RS. RS1 is physically
inaccessible starch locked within cell walls, e.g. partially milled grains,
seeds and legume starches, RS2 is native starch granules that are
resistant, for instance from green banana, raw potato and high
amylose maize (HAM). RS3 is retrograded crystalline non granules,
e.g. cooked, cooled potato and retrograded HAM starches, RS4 is
chemically modified to inhibit or limit amylase digestion;
repolymerised dextrins with altered glycosidic linkages produced by
acid or heat treatment and purified e.g. chain linkage altered dextrins
are also included in RS4. Higher amylose levels in the starch are
associated with slower digestibility or greater resistance to digestion.
High-amylose maize producing RS has been particularly useful in the
preparation of foods (7).
adipose cells, thereby lowering blood glucose level. RS containing
foods release glucose slowly resulting in lowered insulin response
and greater access to and use of stored fat. This helps in
management of diabetes and impaired glucose tolerance, and hence
in the treatment of obesity and weight management. Literature on the
dietary requirements for diabetics is controversial. According to the
American Diabetes Association (ADA), individuals with diabetes
should derive a major portion of their calories from starchy foods, and
limit sugar and protein intake to USDA-recommended levels. Current
comparative diet studies suggest that low fat, high carbohydrate diet
recommended by the ADA may not be as beneficial as a diet low in
carbohydrates and high in unsaturated fats. There are number of
studies on effect of various forms and doses of RS on glucose
(glycaemic) and insulin responses, but give contradictory results. Few
studies have reported on improvement following the consumption of
RS rich food (12-14), while others have showed no effect (15-17).
The physicochemical properties of foods can directly affect the
amount of RS present. In the study of Heijnen et al. (18), RS when
provided in a pudding resulted in lowered postprandial glucose
response and the same RS when incorporated in bread roll did not
affect insulin or glucose response. Behall et al. (19) reported no

26
significant effect on glucose responses or insulin sensitivity following
5 weeks of feeding a high RS diet. Kim et al. (33) showed no
improvement on glucose or insulin concentration in streptozocin
induced diabetic rats fed RS rich diet. More research is needed to
examine the effect of RS on insulin sensitivity using validated
methods. The role of food matrix also needs to be investigated.
GLYCAEMIC INDEX AND GLYCAEMIC LOAD
The ability of particular food to elevate postprandial blood glucose
concentration is glycaemic response or gycaemic index (GI). GI is
measured as the incremental area under the blood glucose curve
after consumption of 50g of available carbohydrate from a test food,
divided by area under the curve after eating a similar amount of
available carbohydrate in a control food (generally white bread or
glucose). Foods with high GI values release glucose rapidly into
blood stream (i.e. elicit a rapid glycaemic response), while food with a
low GI value release glucose more slowly into the blood stream and
result in delayed glycaemic and insulinamic response (31). With the
consumption of high amylose (RS) starch, insulin response reduced
by 17 percent (12).
Glycaemic index refers to the nature of carbohydrate in a food.
However, when people eat meals (different foods) generally
carbohydrate foods are eaten along with protein and fat. Glycaemic
load (GL) takes into account both carbohydrate content per serving of
food and its GI value i.e. the quantity and nature of carbohydrate
present. It is possible to lower GI by replacing carbohydrate content
with protein, fat or other lower GI carbohydrate such as RS (32).
SHORT CHAIN FATTY ACIDS (SCFA)
SCFA are the metabolic products of anaerobic bacterial fermentation
of polysaccharides, oligosaccharides, protein, peptide and
glycoprotein precursors in the large intestine, including those derived
from dietary fiber and RS (33). The principal SCFA are butyrate,
propionate and acetate, although other SCFA are also produced in
lesser amounts (34). SCFA are the preferred respiratory fuel of the
cells lining the colon (colonocytes). They increase colonic blood flow,
lower luminal pH and help prevent the development of abnormal
colonic cell populations (35). SCFA are mainly found in the proximal
colon where fermentation is greatest, and the amount present mirrors
supply of carbohydrate in the diet (36). Depending on diet, total SCFA
concentrations are usually between 70 and 140 mM in the proximal
colon and 20-70 mM in the distal colon; therefore, SCFA are found in
much lower amounts in the distal colon (the site of many colonic
diseases and most human colon cancers). Therefore, dietary
interventions that increase the amount of SCFA in the colon are
thought to be beneficial to gut health.
Carbohydrates that are not digested in small intestine will enter the
colon, those that are fermentable will be salvaged as SCFA in the
colon and may stimulate colonic micro flora, such as bifidobacteria.
More important aspect of colonic fermentation is stimulation of colonic
micro flora which may assist in the biotransformation of bioactive food
components including the cleaving of plant phenolics and from their
glycone to produce the more rapidly absorbed aglycone (37).
Increasing SCFA production also lowers colonic pH and increases the
excretion of bile acids. A lowered pH is thought to be protective
against colorectal cancer and inhibits the transformation of primary to
secondary bile acids. Secondary bile acids are cytotoxic to colonic
cells and are thought to be tumor promoters (38). Therefore, RS may
also confer benefits to gut health via the actions of SCFA on pH and a
reduced production of secondary bile acids.
GUT DISORDERS AND COLON CANCER
DNA adducts are complexes formed from the reaction of toxic
chemicals or their metabolites with cellular DNA. The presence of
DNA adducts reflects exposure to toxic chemicals and their
bioaccumulation throughout life. In the colonic mucosa increased
levels of DNA adducts are thought to increase cancer risk (38). The
proliferative activity of epithelial cells is thought to be an intermediate
risk marker for colorectal cancer (39). Improved colon function is
associated with increased production of SCFA, lower pH, lower
production of ammonia and phenol, decreased secondary bile acid
excretion, reduced cytotoxicity of fecal water, reduced transit time and
altered bacterial activity. A low acid and high concentration of SCFA is
thought to prevent overgrowth of pH sensitive pathogenic bacteria
(35). Most RS is readily fermentable and is a good source of SCFA
such as butyric acid (BA) in colon. Butyrate has been observed to
induce and influence gene expression through its effect on
transcription (40). BA has also been observed to induce apoptosis
and reverse the resistance of colonic cancer cells to programmed cell
death (41). The half life time of BA is very short, and any effect of BA
on colon can be expected when there is a consistent production of BA
over a large segment of the colon.
Many studies have been done on the impact of consumption of
substrates which generate high amount of butyrate (wheat bran,
insulin, fructo oligosaccharide and RS) in the colon. Pierre et al. (42)
studied Min mice and observed that short chain fructo
oligosaccharide reduced the incidence of colon tumors, and
concomitantly developed gut associated lymphoid tissue. Neither
starch free bran nor RS3 modified the number of tumors. Hence
further studies using several models are required.
PREBIOTIC
Starch
Probiotics are strains of living bacteria that survive the passage of the
stomach and are able to adhere to the intestinal wall of the small
intestine and to colonise the large intestine whereas prebiotics are
"growth substrates specifically directed towards potentially beneficial
bacteria already resident in colon". Prebiotics stimulate growth and /or
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activity of bacteria in colon, and improve colon health. Synbiotics refer
to a mixture of prebiotic and probiotic where there is a synergistic
interaction between the two. RS appears to function differently than
well known prebiotics (fructooligosaccharides) (36). It has been found
that only small proportion of ingested organisms reach the colon, and
as probiotic consumption decreases these organisms are washed out
of the gastrointestinal tract. These losses are avoided by RS which
gives physical protection by slowing the rate at which the bacteria are
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lost once probiotic consumption ceases. RS supplementation in
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association with oral hydration therapy reduce fluid loss and halve
recovery time when fed to people with cholera induced diarrhea (36).
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LIPID METABOLISM
RS appears to affect lipid metabolism based on studies in rats where
reduction in a number of measures of lipid metabolism are observed
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 such as total lipids, total cholesterol (33), various lipoprotein fractions
in blood (21, 22). Reported data indicate that replacement of 5.4
percent of total dietary carbohydrate with RS significantly increased
post-prandial lipid oxidation and therefore could decrease long term
fat accumulation (23, 24).
SATIETY AND WEIGHT LOSS
Respiratory quotient (RQ) is a relative measure of oxygen uptake and
is indicative of the use of fat/carbohydrate as fuel. A high RQ is
reflective of high carbohydrate oxidation. Achour et al. (25) observed
the effect of RS on RQ during a post absorptive period i.e. 27h after
an initial RS rich mixed meal and 10 h after second identical RS rich
mixed meal. They found significant increase in RQ which might be
due to increased bacterial fermentation in the colon. RS may be of
benefit to healthy individuals who are trying to achieve and maintain a
healthy body weight. Ingestion of a diet high in RS can delay
postprandial carbohydrate oxidation and increase satiety in healthy
subjects. Delayed hunger after a meal has the potential of helping
subjects to control their total energy intake at the appropriate level to
maintain or lose weight (26-28). RS has been examined as a satiety
agent. Roos et al. (29) reported that RS was more satiating than
glucose. Skrabanja et al. (30) reported that bread rich in RS imparted
greater satiety than white bread. These studies also showed a
decrease in glucose levels following consumption of high RS meal.
RS was also known to reduce the activity of lipogenic enzymes such
as fatty acid synthases (the rate limiting enzymes in fat synthesis)
(10). RS may result in smaller fat pad size and /or mass due to
Starch
reduced glucose uptake and lipogenesis by the fat cells (23).
CONCLUSIONS
RS is an exciting ingredient having proven physiological benefits
similar to soluble fiber. Day by day RS is gaining importance due its
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contribution in various health aspects such as modification of blood
glucose and GI, lipid metabolism. Interest in RS as a prebiotic is on
the rise. It is likely that RS exerts some or all its effects through the
action of SCFA. The potential of RS in weight management and
maintenance is challenging in the face of increasing trends of obesity.
However in certain areas of research, which have generated
controversial results further work needs to be done to clearly establish
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the exact mechanism of action of RS.
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