Chemistry Reference
In-Depth Information
6.6 IMMuNE FuNCTIoN TrEATMENT oF ACuTE DIArrhEA
Resistant starch stimulates the growth of various bacterial genera, in particu-
lar, facultative anaerobic organisms. RS increases the counts of bifidobacteria,
,
lac-
tobacilli, eubacteria, bacteroides, enterobacteria, and streptococci (Kleesen et al.,
1997; Degnan et al., 1997). The enhanced counts of lactobacilli inhibit the growth of
pathogenic bacteria, such as certain
E. coli
strains or sulfur/sulfate-reducing anaero-
bic bacteria.
Due to prebiotic and symbiotic properties of RS, RS2 ingredients made from
HACS have been proposed for adjunct therapy to oral rehydration solution (ORS) for
acute diarrhea (Binder and Ramakrishna 1998). Consumption of RS assists in recov-
ery from infectious diarrhea in humans and animals (Topping et al., 2003). In three
studies in India, RS2 from HACS improved water retention for children, adolescents,
and adults suffering cholera-like diarrhea or acute diarrhea (Ramakrishna et al., 2000,
2008; Raghupathy et al., 2006). In a study of Ramakrishna et al., (2008), 50 adult
males with severe watery cholera-like diarrhea of less than 3-day duration and moder-
ate to severe dehydration were randomized to receive hypo-osmolar oral rehydration
solution (HO-ORS) with or without high-amylose maize starch 50 g/L (substituted for
glucose, HACS-ORS). Compared to HO-ORS, HACS-ORS reduced diarrhea duration
by 55 percent and significantly reduced fecal weight after the first 12 hours of ORS
therapy in adults with cholera-like diarrhea. This study confirmed the previous finding
that the addition of an RS to ORS (50 g HACS per liter of ORS) reduces fecal fluid
loss and shortens the duration of diarrhea in 48 adolescents and adults with cholera
(Ramakrishna et al., 2000). In young children (6 months to 3 years) with acute diar-
rhea, the addition of HACS to glucose ORS (standard World Health Organization ORS)
significantly shortened duration of diarrhea compared with glucose ORS treatment
(Raghupathy et al., 2006). Time to first formed stool was also significantly shorter in
children receiving HACS-ORS (median, 18.25 hours) compared with children receiv-
ing glucose ORS (median, 21.50 hours) (
p
< 0.05). In the HACS group, there was a
tendency to have a lower mean stool weight in first 24 hours (
p
= 0.0752) as well as a
lower total diarrheal stool weight (
p
= 0.0926).
In children, specific classes of fecal bacteria were lower during acute diarrhea
than during a normal period, indicating alterations in the bacterial flora during diar-
rhea (Balamurugan et al., 2008). Altered flora of anaerobic bacteria may be due to
colonization of the intestine by pathogens and to rapid intestinal transit (Balamurugan
et al., 2008). In children with acute diarrhea, the numbers of
Bacteroides-Prevotella-
Porphyromonas
group,
E. rectale, L. acidophilus,
and
F. prauznitzii
groups were
low as compared with their levels after recovery from diarrhea. Administration of
amylose maize starch as an adjuvant therapy was associated with lower levels of
F. prauznitzii
at the time of recovery, indicating that HACS had an impact toward
establishment of more desirable microflora during diarrhea (Balamurugan et al.,
2008). RS also have a positive impact on IgA. Morita et al. (2004) reported that rats
fed high-RS2 diets containing HACS had higher intestinal and fecal IgA.
