Resistant Starch Update

Resistant Starch (RS) is a type of carbohydrate that is resistant to digestion which makes it a soluble fiber as far as our digestive processes are concerned. It generally will not raise your BG, but as I found out, it may raise it slightly. The reasons for using RS generally include the following benefits to diabetics (from Wikipedia):

- Decreased glycemic response in healthy individuals, decreased glycemic response in diabetics.
- Increase insulin sensitivity in healthy individuals,individuals with Type II diabetes as well as insulin resistant individuals.One study found a 50% increase in insulin sensitivity in overweight men consuming 15 grams of resistant starch/day for 4 weeks. One additional study found that 12 grams of ingredients containing resistant starch did not improve insulin sensitivity in African American adults at risk for diabetes.
-Increase glycemic health of next generation when fed to pregnant mothers An animal study demonstrated that when RS2 resistant starch from high amylose corn was fed to pregnant, diabetic rats, it resulted in increased insulin sensitivity and preservation of beta-cell mass within the pancreas of the dams as well as lower fasting blood glucose levels in the pups.
-Improves first phase insulin secretion A human clinical trial demonstrated improved first phase insulin secretion when RS2 resistant starch from high amylose corn was fed to overweight, insulin resistant adults.

So over the last several months I have been trying Resistant Starch to see if it would live up to its promises. This generally called an N=1 test. I started with 5 grams of Bob's Red Mill Potato Starch and worked up to 35 grams over several weeks. It has now been 75 days since I started. On the positive side I have seen an improvement in my regularity, but for BG control it is a disappointing story.

While at first I thought that RS was indeed helping to control my BG, I no longer think that I can see any improvement with my BG control or with carb tolerance by using RS. If anything, I have seen a small increase in my fasting BG, and a more modest increase in my overall BG throughout the day making my BG control slightly worse. So I am disappointed.

The reason I thought at first I was seeing a modest improvement was because I was only looking at my postprandial data set. My first test was a simple t test of means by dividing the postprandial data in the middle and computing the average of both (shown in red in the plot below). The first part represented the adjustment period and second part represented the benefits. The test showed that they were quite significantly different (P=0.0002) giving an improvement of 7 mg/dl.



It was not until I looked at my other data that I realized that the significance was bogus. I was too trusting in the 'fact' that RS would not increase my BG. To be fair my own preliminary tests did not seem to show any increase either. However, it is fairly obvious from the plots that my BG did increase, particularly during the 30 day adjustment period. So what I was seeing was the drop that occurred after the adjustment period. Only the drop does not seem to be as much as the rise giving a slightly overall negative result.



[Note that the data in the above plot is smoothed 10 day moving average data. The reason for this is to see the trends more easily. A moving average will also tend to remove meter errors assuming that the meter errors are somewhat normally distributed and not significantly biased.]

To see if RS was statistically significant I did a regression fit using RS and found that the difference between bed time and fasting was significant (P=0.004) for RS. This relationship predicts that RS caused those differences to slightly increase (~4 mg/dl) making my blood glucose control slightly worse. It is also graphically obvious by looking at the fasting and evening BG in the above figure that both increased slightly during the period I have been taking RS when compared to the previous couple of months of data. It is not a lot but it is going in the wrong direction. Also note that the pattern seems to be amplified as you look upwards from the fasting to the postprandial.

It is, of course, possible that there are confounders that could also explain these findings and perhaps I should give it some more time, but it has already been more than two months since I first started taking RS. I don't think that it is my gut microbiome because I am having quite vivid dreams (one of the 'benefits' of RS) after starting RS and my bowel movements have become normal, so it appears that I have adjusted to RS.

So I posted this information on a site promoting RS called Mr. Heisenbug (http://mrheisenbug.wordpress.com). I explained my own experiment and my disappointment. I then asked if anybody knew of any studies showing the benefit of RS for T2DM.

TATERTOT responded helpfully and pointed me to http://www.ncbi.nlm....les/PMC3987287/ titled "Efficacy of increased resistant starch consumption in human type 2 diabetes."

As I was reading this paper a few of things stood out. The BG improvement due to RS is somewhat modest (I estimated the first order effect on HbA1c at a 0.01 reduction) and the authors indicated that they do not expected changes in HbA1c to be easily detectable (the study itself detected no change in HbA1c). Its primary effect on BG is by lowering postprandial peaks by about 20 mg/dl in T2DM patients who ate enough carbs to raise their BG to the 140 to 160 range and had an HbA1c around 6.5%. Since there was no change in insulin response the authors think that the benefit is due to an insulin-independent mechanism (e.g., increased glucose uptake via increased GLP1).

I also noted that there are differences from my own case and the T2DM patients studied. The patients were overweight and had an HbA1c around 6.5%. I have a normal weight (BMI 21), in ketosis, and have an HbA1c of 4.7%. This was also pointed out by Mr. Heisenbug who said:

"Maybe I’m misreading something, but your numbers look very, very healthy and normal. Might I suggest that RS didn't “fix” anything because there’s nothing to fix?"

To which I responded by saying that I had a lot to fix since I was very carb intolerant and had to eat ~5 grams of carbs per meal in order to maintain my good control.

He then replied saying:

"Ah, I understand now."

"I have to say, I think ketosis is a real confounding factor. Ketogenic dieting itself induces/exacerbates carb intolerance."

"If I really wanted to test the ability of RS to improve BG and carb tolerance, I would drop the ketogenic stuff and reintroduce a reasonable portion of carbs/starches into my diet. In other words, remove the confounding factor of ketosis by reacclimating to carbs. I just think ketosis is too unique of a state to accurately measure anything. But I understand why that might not be an easy or desirable option."

So he is saying that the very process that enables my good control is the reason for the lack of results. I already know that I have physiological insulin resistance and like Peter at Hyperlipid said I not sure I really care since my HbA1c is in the 4% club, but still I was hoping that RS would reduce my carb intolerance. And my reading of the promise benefits of RS suggested just that.

What Mr. Heisenbug seems to be pointing out is that RS works to reduce higher levels of BG. And based on my own N=1 experiment I not even sure it really works at a meaningful level at all to control BG. I now think that RS is at best a tertiary effect when compared to carb reduction and medication, and it may even be slightly counterproductive. I now put RS in the same category as vinegar and cinnamon with respect to BG control. YMMV! I do concede that it is possible that it has a modest beneficial to those who reject carb restrictions, but their BG control is in diabetic ranges so slightly lowering BG may lead to slightly less diabetic complications. Given what I know about diabetic complications I will go with carb restrictions.

It's my fault that I did not look deeper to see that the results of RS were modest at best and that the claims, while perhaps having scientific and statistical significance, may have questionable real world use. I would like to think that I am wrong, but my hype detector has now been triggered for the claims that RS improves BG control.

In the meantime I have decided not to quit taking RS but to cut back on RS primarily because RS has seemed to improve my bowel movements and I do not want to interfere with that benefit. It is wonderful not to have to worry about something that should be a normal function. However, it may not be the RS. Perhaps it is because I have been eating fresh unwashed vegetables from the garden that has helped to repopulate my gut microbiome. Perhaps it is the other probiotics including my own fermented vegetables from the garden. Perhaps it is just my body responding to 7 months of normal BG and slowly healing. Or perhaps it is some combination. I'll be doing some experimentation over the coming weeks to see if I can resolve these effects.

I'm in awe of your ability to measure all this stuff - I don't seem to have the mindset for rigorous record keeping and isolating variables, etc. I've dabbled with RS a couple of times and all it does is make me sweat, give me dreams I'd rather not have and even with small amounts the stomach pains usually make me stop pretty quickly. I'm very nervous of it given my history with IBS and SIBO - any pain nowadays makes me worry that I'm having a recurrence and I definitely don't want to go down that route again.

Now you've done the experiment and discovered the effects are minimal, I have even less reason to wonder so thank you

I did not mention it, but RS also gives me vivid dreams. A lot of other people get these too. It is kind of a weird phenomenon and was a recent topic on Mr Heisenbug's site.

I still think that gut health is important, but I also think that RS benefits for diabetics may have been oversold. It's biggest benefit seems to be for diabetics who still eat a lot of carbs and even then the study showed little impact on HbA1c which I consider to be a major bio marker for health.

Great post OldTech

Some time ago I started to read lot’s of information over at the free the animal blog on resistant starch. Checking around other sites the RS hype at fta seemed to me to be way over the top. I made a few comments, and was told by RN in no uncertain terms, I did not know what I was talking about. Since then I have seen some very high profile bloggers in the US jumping on the RS bandwagon as if it was the holy grail of health.

Your tests and observations are in line with others who have given RS a go. One thing is for sure, for a type two diabetic, nothing comes remotely close for dropping BG numbers than a stiff reduction in carbs, or of course injected insulin. I have found over the years, when someone high profile, is making a lot of noise about a new wonder method of BG control whatever, it usually means a book or DVD is on the way.

In the early days I tried just about everything to fool the betus, it can’t be done. I believe once you have found something that works stick with it, don’t try to fix what ain’t broke. By all means do some tweaking with vinegar, cinnamon RS etc. but don’t expect any miracles. Let’s not forget, the low carb high fat method of diabetes control, has been around for over a hundred years, it worked back then and it works today. If something sounds too good to be true, it usually is a let down, but it can shift a lot of books.

Regards Eddie

I think that Michael Ruscio's video from AHS is well worth watching - he admits that what is known so far is basically the tip of the iceberg. There's still a hell of a lot to learn and my gut health improved tremendously from a low carb diet, so I'm really hesitant to change things too much. I think Wooo and Bill Lagakos's take on RS seems pretty rational - I know I'm eating heaps more fibrous veggies now than I was previously. I eat nuts which contain RS. I use vinegar and magnesium for insulin sensitivity. My Vitamin D3 status is now fine. If I'm going to add more fibre or RS, I'd much rather get it from real and/or fermented food than from uncooked flours. Even eating too much sauerkraut without introducing it slowly gave me a gut reaction that I'm in no hurry to repeat.

I've bumped this topic thread up ...because on the Lindt 90% cocoa chocolate thread there has been some interesting exchanges about resistant starch. Yes off topic for chocolate maybe but still interesting. Shame in a way we can't combine/cross over the relevant points! But never mind.

Of course resistant starch / reheated pasta etc is definitely in the news these days

All the best Jan

If I am going completely batshit just let me know, but how about this. This was posted elsewhere by someone I have great respect for. A type one diabetic with great control who does a great deal of work on the scene and in private helping the cause, especially lowcarb.

"At 2AM my BG was 10.9 and when I woke up it was at 9.6; a net rise of 2 mmol/l for 50g of pasta (containing the same amount of carbs as half a bottle of lucozade) is pretty good in my book. So for this experiment, it looks very encouraging so far! Very exciting stuff!"

10.9 9.6 who wants to see those sort of BG numbers on a BG meter, certainly not me. Resistant starch may have some useful properties, but as a tool to bring down BG numbers by any appreciable amount, forget it. OldTech has posted some very scholarly stuff on the subject and his experience is close to other peoples I have read about re BG. As he says very low carbers 30 a day or less may get some improvement with gut bacteria, but I do not think many will find it a useful way of reducing bG numbers.

The bottom line, the foods that are supposed to have starch reduced such as spuds and pasta (by cooking and cooling and re heating etc,) I learned to do without nigh on seven years ago, I sure ain't going to start meddling around with a bowl of pasta to see 9 on my meter instead of 11, get my drift ? good.

Eddie

It's all rather complicated, but would I be right in summarising the Resistant Starch method as,

A brilliant method of bringing your blood glucose down by around 1mmol, IF you are prepared to abandon the method (low carb) which has already brought your numbers down by 10 to 15 mmol, or maybe more.

Who'd be that sort of prat for a bowl of cold spaghetti?
Sally

With all due respect to anyone who partakes in such experiments with RS-I'm sticking to what I KNOW works well for me and would NOT be happy with those PP levels in any shape or form...That's just my opinion though,to me,the clues in the name 'Starch' and that's all I need to know.

It's time I did an update since the last 6 weeks have been quite remarkable. In particular my postprandial average readings have gone from 100 mg/dl (5.54 mmol/l) to 83 mg/gl (4.6 mmol/l). The chart below shows my readings for fasting, bedtime, postprandial, and average over the last 6 weeks. All the readings are 10 day moving averages to help remove errors in measurement. What the chart does not show is some of the details. In particular, I found it quite remarkable that three days ago my high for the day was 73 mg/dl (4.05 mmol/l). It seems that carbs are now not having that much effect on my BG.



I cannot fully explain why I am seeing this normalization. I am still taking the RS (50 g per day), but I am also only eating two meals with no snacks. So my hypotheses are now:

1) Nine months of low carbs are finally having a real effect.
2) RS really works only it takes time (months) for the gut to heal especially for diabetics.
3) Two meals per day are quite effective. It allows one meal to be fully processed before the next. Now my lowest readings for the day are often just before dinner. It is not uncommon to see readings in the low 60's mg/dl (from 3.3 mmol/l to 3.6 mmol/l).
4) Something else. Among other things I now take one clove of chopped garlic with my RS and vitamin K2. The garlic according to Mr Heisenbug may help heal the gut and vitamin K2 is missing from our modern diet. And of course I am still eating 50 grams of peanuts and 2 squares of bakers cacao for 'desert'.
5) Keeping my BG under 100 mg/dl (5.54 mmol/l) is what is needed for the beta cells to heal. At least one study has shown that higher levels of BG are toxic to beta cells.
6) Some combination of the above.

In the mean time I do not plan on making any changes. I still only eat 10-15 grams of carbs per day.

Stella numbers OldTech and as usual a very high quality post. You said "It seems that carbs are now not having that much effect on my BG" but as you are only consuming 10 to 15 per day, that is to be expected. You also said "what is needed for the beta cells to heal" the established science at this stage says when beta cells die they are dead, and do not replace themselves after around thirty years of age.

https://www.llnl.gov/news/newsreleases/2010/Oct/NR-10-10-05.html

Nonetheless you are doing fantastic and have given me much to think about. My worst HbA1c since diagnosis (almost 12) is 6.1 but after a Christmas I might see what a diet of 15 carbs per day max might achieve as an experiment. One thing concerns me is the fact I eat a very wide variety of non starchy vegetables and salad items to obtain what I consider to be a balanced diet. With most of my normal food off the menu, other than fats and proteins, could what's left be considered balanced.

Regards Eddie

eddie1 wrote:You also said "what is needed for the beta cells to heal" the established science at this stage says when beta cells die they are dead, and do not replace themselves after around thirty years of age.

Yes, you are correct about new beta cells. After about age 30 we do not get new beta cells. However, there is another mechanism called regeneration. According to this 2014 report beta cells have the capacity to regenerate.

"The surprising finding, posted online recently by Cell Metabolism, suggests that by understanding how regeneration occurs, scientists one day may be able to stop or reverse the rising tide of diabetes, which currently affects more than 8 percent of the U.S. population."

eddie1 wrote:You said "It seems that carbs are now not having that much effect on my BG" but as you are only consuming 10 to 15 per day, that is to be expected.

Yes that is in general true. However, just a couple of months ago I was eating the same amount of carbs and I was generally seeing postprandial readings between 100 mg/dl (4.55 mmol/l) and 120 mg/dl (6.6 mmol/l). Now my postprandial readings are not much above fasting and my range between fasting and postprandial has gone from 25 mg/dl (1.4 mmol/l) to 10 mg/dl (0.55 mmol/l) .

Interesting. About 4 days or so ago, before I realised this thread existed, I started taking approx 1 tableoon of ground flaxseed with my evening kefir. I have also tried having just 2 meals, or one or two green smoothies plus an evening meal. It will be interesting to see what happens. I try to have plenty of green veg too.

I read a little snippet about flax and kefir helping to heal the body. Perhaps it works in a similar way as Dr Johanna Budwig found in her flax oil and cottage (curd or quark in the UK) cheese. Apparently, the combination triggers an electrical reaction in the oil that sends more oxygen into the cells - or at least that's how I understand it.

I wonder if the type/source of the starch might make a difference?

AliB wrote:I wonder if the type/source of the starch might make a difference?

From what I can tell it only matters if it resistant starch. For more details see resistant-starch-101.

In summary the reason that RS is important is that it feeds the good microbes in your colon. It's called 'resistant' because it is not digested. The microbes in turn produce short chained fatty acids, such as butyric acid, that result in better health and are reported to improve BG.

While there are many sources of RS, it generally comes with too many carbs for those of us who are carb intolerant. So the solution is to add a nearly pure RS source to our diet. A good source is raw uncooked potato starch. Here in the US I use Bob's Red Mill Unmodified Potato Starch. As far as I can tell it has no direct effect on BG. That is we do not digest it so it does not get turned into glucose provided we eat it raw and cold.

IMO everyone who is eating low carb should strongly consider adding RS.

Interestingly, you reckoned its taken about 9 months for the benefits to become apparent.

When I was following the Healing (Naturally by Bee) diet, that also took around 8-9 months for the full healing power to kick in. It didn't include RS, and my insulin sensitivity seemed to actually worsen. Some things improved or reversed, but not the diabetes.

Bee found and sent me Dr. Jan Kwasniewski's Optimal Diet (that her diet is based on) adaptation for diabetes info about 2 years after I had started her diet, but the changes needed for the diabetes version needed to be done from the start and I had been on the basic version too long.

A lot gained great benefits from her diet, but some including myself actually found our sensitivity getting worse. Too much fat, maybe? Dr Kwasniewski's version for diabetes was lower fat and protein and more veg.

Very interesting posts; so you are essentially saying that initially the RS did NOT obviously affect your bg control but you feel that it is beneficial for your bowel and then after some months you noticed an improvement?

Has your insulin resistance improved?

Best

Dillinger

All carbohydrates become resistant if you don't eat it. Reheating carbohydrates seems to make them resistant as said by ‎Michael Mosley on his program.

Moose

I really enjoyed Zoe Harcombe's astute dissection of that program

http://www.zoeharcombe.com/2014/10/trust-me-im-a-doctor-not-on-nutrition/#utm_source=feed&utm_medium=feed&utm_campaign=feed

Dillinger wrote:Very interesting posts; so you are essentially saying that initially the RS did NOT obviously affect your bg control but you feel that it is beneficial for your bowel and then after some months you noticed an improvement?

Has your insulin resistance improved?
Dillinger

Yes, but to be clear what I am saying is that my BG has remarkably improved over the last 6 weeks and that RS may be one of the reasons why, but since I made other changes, including eating only two meals, I don't know that I can just credit RS. I also don't know what has improved. It could be either improved performance of my beta cells or lower insulin resistance.

I may be able to sort of these questions out with more time, but in the meantime I am going to continue to do what I have been doing and monitor what happens.

OldTech wrote:

Dillinger wrote:Very interesting posts; so you are essentially saying that initially the RS did NOT obviously affect your bg control but you feel that it is beneficial for your bowel and then after some months you noticed an improvement?

Has your insulin resistance improved?
Dillinger

Yes, but to be clear what I am saying is that my BG has remarkably improved over the last 6 weeks and that RS may be one of the reasons why, but since I made other changes, including eating only two meals, I don't know that I can just credit RS. I also don't know what has improved. It could be either improved performance of my beta cells or lower insulin resistance.

I may be able to sort of these questions out with more time, but in the meantime I am going to continue to do what I have been doing and monitor what happens.

Hi - hope you don't mind me asking. But just wondered how things were going? I also know you posted a little about your progress on the 'Lindt 90% Cocoa Chocolate' thread.

Many thanks and .......

All the best Jan

Well I am not sure and will need more time to see how things play out. In mid October my postprandial BG average reached a low of 82 mg/dl (4.55 mmol/l). Since then it has been steadily climbing up to 95 mg/dl(5.27 mmol/l). It now looks like it MIGHT be trending down again but it much too soon to know for sure.

My other averages still look good. My fasting BG is now 68 mg/dl (3.77 mmol/l) and my overall average has come up slightly to 80 mg/dl (4.44 mmol/l).

So I am still not convinced that RS should be given credit, but I am leaning that way. I do know that I plan on continuing only two meals with no snacks especially since it seems quite painless to do so after about the first week. My only concern is the rise in postprandial, but that seems to have peaked (fingers crossed).

The chart below shows my average BG over the last 90 days.



Note: All results are 10 day moving averages.

Thanks OldTech yet another stunning post for sure. One thing is beyond doubt, your BG control is as good as it gets in my opinion.

Regards Eddie

Thank you so much for posting this .....as members/readers know I am not diabetic but live the LCHF lifestyle.

Your numbers seem to be very good and your charts clearly set everything out so well.

As many will know, reading other articles / blogs / forums RS can cause many discussions but surely it's good to talk and discuss relevant and important points with each other?

I think your blood sugar numbers are excellent, and thank you for sharing your experience with us.

All the best Jan

Very interesting link posted on the low carb diabetic blog today - apparently both Dr BG and Tim Tatertot are now backing away from raw potato starch because of possible liver side effects:

http://drbganimalpharm.blogspot.co.nz/2014/11/bifidobacteria-longum-roseburia-f.html?showComment=1415989673134#c2726818441465987004