Banana Starch in Diarrhea
Banana Starch in Diarrhea
By Carol A. Kemper, MD, FACP, Clinical Associate Professor of Medicine, Stanford University, Division of Infectious Diseases; Santa Clara Valley Medical Center, Section Editor, Updates; Section Editor, HIV; Associate Editor for Infectious Disease Alert.
Dr. Kemper does research for GSK Pharmaceuticals, Abbott Laboratories, and Merck. Physician editor Stan Deresinski, MD, FACEP, Clinical Professor of Medicine, Stanford, Associate Chief of Infectious Diseases, Santa Clara Valley Medical Center, serves on the speaker's bureau for Merck, Pfizer, Wyeth, Ortho-McNeil (J&J), and Cepheid. Peer reviewer Connie Price, MD, Assistant Professor, University of Colorado School of Medicine, reports no financial relationships relevant to this field of study.
Source: Rabbani GH, et al. Green banana reduces clinical severity of childhood shigellosis. Ped Infect Dis J. 2009;28.
This article originally appeared in the June 2009 issue of Infectious Disease Alert.
The role of amylase-resistant starches, which are not digested in the human small intestine, as dietary therapy of various bowel diseases, such as infectious diarrhea, is not well understood. Starch-based oral solutions have been found to be beneficial in inflammatory bowel disease, ulcerative colitis, as well as cholera and non-cholera diarrhea. Green banana, which is high in amylase-resistant starch, is used as a digestive aid for children in many parts of Asia, Africa, and Latin America, and turns up as a folk remedy for diarrheal illness in some parts of the world.
Rabbani et al examined the effects of a green banana-containing diet on 73 children (ages 6 to 60 months) with Shigellosis. In a double-blind, controlled study, children were randomized to receive a rice-based diet with or without green banana. Green banana was prepared by boiling the whole fruit for 7 to 10 minutes, removing the peel, and creating a paste from the inner pulp. Rice flour was added, so the total calories were similar, and vanilla and strawberry flavoring were added so the taste of the two diets was similar. All of the children received ciprofloxacin (15 mg/kg/day for five days). Oral rehydration solutions were available, and simple, soft foods, such as bread and potatoes, were allowed as tolerated.
The addition of green banana was associated with greater frequency of clinical success at five days of therapy compared with the control group (85% vs. 67%, p = .001). Stool frequency was reduced in those receiving green banana vs. the control group (70% vs. 50%, p < .01), and fecal volume was also reduced. Fecal blood was cleared in 96% vs. 60% of those with or without green banana, respectively. Clinical improvement was also observed at three days of therapy, but the results were not statistically significant. In addition, stool fatty acid concentrations were significantly higher in the GB group.
Amylase-resistant starches appear to stimulate colonic flora, which break down the starches into short-chain fatty acids. These fermentation by-products are a major source of energy for colonocytes and may help to protect colonic mucosa, reducing fecal myeloperoxidase activity and diminishing invasion by bacteria. Though not part of the discussion here, certain kinds of rice may also have some beneficial effects on the digestive system, depending on the type of rice available for use. Rice starch is made up of both amylopectin and amylose, but the latter is less readily digested. That is why some rices, such as risotto rice (e.g., Arborio), which are higher in amylopectin and are more readily digested by salivary enzymes, taste sweeter and yield creamier foods with cooking. Others, such a longer grain rice (e.g., Jasmine) have higher amounts of amylose, which is less readily digested in the human mouth and intestine to sugars, and, therefore, is better for diabetics.The role of amylase-resistant starches, which are not digested in the human small intestine, as dietary therapy of various bowel diseases, such as infectious diarrhea, is not well understood.
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