Resistant Starch Formation in Cooked Starches

Mechanism and Effects

Gelatinized and retrograded starches (RS type 3) form when cooked starchy foods are cooled, creating resistant starch, according to the American Diabetes Association guidelines 1
Resistant starch produces lesser increases in postprandial glucose than digestible starch, with correspondingly lower insulin levels, as noted by the American Diabetes Association 2, 3, 4, 5, 6
Resistant starch is fermented in the colon and produces approximately 2 kcal/g of energy, versus 4 kcal/g for regular starch, as reported by the American Diabetes Association 2, 3, 4, 5, 6
Resistant starch may modify postprandial glycemic response and reduce hyperglycemia, according to the American Diabetes Association 2, 3, 4, 5, 6, 7

The American Diabetes Association suggests that the total amount of carbohydrate in meals remains more important than the source or type for glycemic control 7
For patients seeking to reduce glycemic impact of rice and bread, the American Diabetes Association recommends cooking then cooling in the refrigerator for 24 hours before consumption, as an adjunctive strategy to total carbohydrate counting and portion control 7

The American Diabetes Association notes that while resistant starch may modify postprandial glycemic response and reduce hyperglycemia, there are no published long-term studies in subjects with diabetes proving sustained clinical benefit 8, 9

The European Food Safety Authority recognizes that replacing digestible starch with resistant starch reduces postprandial glucose, but requires at least 14% of total starch to be resistant starch for health claims 10, 11

The American Diabetes Association guidelines emphasize that for patients on intensive insulin therapy, premeal insulin dosage should be based on total carbohydrate content, not glycemic index 12, 13
The American Diabetes Association recommends that glycemic index, fiber, fat, or caloric content of meals do not affect the premeal insulin dosage required 12, 13
The American Diabetes Association suggests that for patients on fixed insulin regimens, day-to-day consistency in carbohydrate amount is more important than glycemic index 14, 12
The American Academy of Family Physicians notes that the way grains are processed determines glycemic index more than cooling alone, with finely ground grains digesting more quickly than less processed grains 15

Total carbohydrate content remains the priority for glycemic control, not glycemic index modifications 14, 12, 13
The American Diabetes Association guidelines recommend controlling total portion size and carbohydrate content as the primary strategy for glycemic management 14, 12, 13