Modulation of the Gut Microbiota by Resistant Starch as a Treatment of Chronic Kidney Diseases: Evidence of Efficacy and Mechanistic Insights

Abstract

Chronic kidney disease (CKD) has been associated with changes in gut microbial ecology, or "dysbiosis,"which may contribute to disease progression. Recent studies have focused on dietary approaches to favorably alter the composition of the gut microbial communities as a treatment method in CKD. Resistant starch (RS), a prebiotic that promotes proliferation of gut bacteria such as Bifidobacteria and Lactobacilli, increases the production of metabolites including short-chain fatty acids, which confer a number of health-promoting benefits. However, there is a lack of mechanistic insight into how these metabolites can positively influence renal health. Emerging evidence shows that microbiota-derived metabolites can regulate the incretin axis and mitigate inflammation via expansion of regulatory T cells. Studies from animal models and patients with CKD show that RS supplementation attenuates the concentrations of uremic retention solutes, including indoxyl sulfate and p-cresyl sulfate. Here, we present the current state of knowledge linking the microbiome to CKD, we explore the efficacy of RS in animal models of CKD and in humans with the condition, and we discuss how RS supplementation could be a promising dietary approach for slowing CKD progression.

Consumption of Cooked Black Beans Stimulates a Cluster of Some Clostridia Class Bacteria Decreasing Inflammatory Response and Improving Insulin Sensitivity

“…The purpose of this study was (1) to determine the effect of consumption of dry cooked black bean (BB) in a control or a high-fat diet with 5% sucrose in the drinking water (BB + HF + S) compared to those fed casein (C) in a control or high-fat diet with 5% sucrose in the drinking water (C + HF + S) on the gut microbiota, to study the effect of the type of protein and the presence of resistant starch in the BB, and (2) to study the effect of an acute metabolic challenge with glucose after the consumption of BB in rats fed control or high-fat diet on insulin signaling and G-protein-coupled receptors GPR43 and GPR41 and hepatic flavin monooxygenase 3 (FM03) protein abundance, to determine the protective effect of long-term consumption of a vegetable protein, such as BB, with resistant starch compared to an animal protein, such as casein, on insulin resistance. Study 1.…”

“…RS type 4 (RS4) is formed via chemical cross-linking of starch by the addition of esters and ether groups. RS4 are usually developed for use in processed foods [1,2]. Upon entering the colon, RS undergoes a high degree of anaerobic fermentation by the local microbiota into hydrogen, methane, carbon dioxide and short-chain fatty acids (acetate, propionate, and butyrate).…”

A Renal Clinician's Guide to the Gut Microbiota

“…low-protein diets, 100 supplementation of dietary fiber (i.e., resistant starch, 101,102 arabinoxylan oligosaccharides 103 ), synbiotics, 9,82 and hemodiafiltration. Recently, the infusion of a binding competitor, ibuprofen, during dialysis led to a reduction in serum levels of indoxyl sulfate and p-cresyl sulfate.…”

Exploring the role of the metabolite-sensing receptor GPR109a in diabetic nephropathy

“…The use of dietary therapies that directly target the gut microbiota to increase SCFA production, namely probiotics and prebiotics, have recently been investigated as possible interventions to limit DN [9].…”

“…Resistant starch (RS) is a type of dietary fibre that acts as a prebiotic. Numerous studies have illustrated that supplementation with RS is associated with an increase in the microbial production of SCFAs, particularly butyrate [9]. A commonly used source of resistant starch is high amylose maize starch (HAMS) and in an obese model of diabetes, the Zucker diabetic fatty rat, six weeks of supplementation with a diet containing 55% HAMS (Amylogel, equivalent to 20% RS) was associated with a reduction in albuminuria [10].…”