Resistant starches.
Initially, it was hoped that resistant starches (ie, starches that enter the colon) would have clear advantages in the reduction of colon cancer risk and possibly the treatment of ulcerative colitis. Recent studies have confirmed the ability of resistant starch to increase fecal bulk, to increase the molar ratio of butyrate in relation to other short-chain fatty acids, and to dilute fecal bile acids. However, reduction in fecal ammonia, phenols, and N-nitroso compounds have not been achieved. At this point the picture from the standpoint of colon cancer risk reduction is not clear. Nevertheless, there is a fraction of what has been termed resistant starch (RS1), which enters the colon and acts as slowly digested, or lente, carbohydrate. Foods in this class are low glycemic index and have been shown to reduce the risk of chronic disease. They have been associated with systemic physiologic effects such as reduced postprandial insulin levels and higher high-density lipoprotein cholesterol levels. Consumption of low glycemic index foods has been shown to be related to a reduced risk of type 2 diabetes. Type 2 diabetes has in turn been related to a higher risk of colon cancer, especially colon cancer deaths. If carbohydrate has a protective role in colon cancer prevention, it may lie in the systemic effects of low glycemic index foods. The colonic advantages of different carbohydrates, therefore, remain to be documented. However, there is reason for optimism about the possible health advantages of so-called resistant starches that are slowly digested in the small intestine.
Jenkins
D J
DJ
Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Canada.
Kendall
C W
CW