Resistant starch (RS) is the sum of starch and products of starch degradation not absorbed in the small intestine of healthy individuals. There are a number of RS with different characteristics which may have a different fate in the colon. As a consequence, all RS should not be considered equivalent as far as physiological properties are concerned; indeed, they may have a different impact on colonic health. This statement may explain part of the apparent contradictions in the literature on RS and cancer or inflammatory disease prevention. RS is fermented in the large intestine into short-chain fatty acids and, among those, butyrate, which is recognized as the main nutrient of the colonocyte. This fermentation pattern seems to be responsible for most of the effects of RS on colonic health. Another important property is linked to its ability to lower colonic pH, which is usually considered as beneficial for mineral biovailability in the colon or cancer prevention. Due to their fate in the digestive tract, RS materials do not seem to have any significant impact on glucose absorption or metabolism. On the contrary, they may have a hypocholesterolemic effect, but available information is contradictory.