Starch is the major glycemic carbohydrate in foods, and its nutritional property is related to its rate and extent of digestion and absorption in the small intestine. A classification of starch into rapidly digestible starch (RDS), slowly digestible starch (SDS), and resistant starch (RS) based on the in vitro Englyst test is used to specify the nutritional quality of starch. Both the RDS and RS fractions have been extensively studied while there are only limited studies on the intermediate starch fraction of SDS, particularly regarding its structural basis and slow digestion mechanism. The current understanding of SDS including its concept, measurement method, structural basis and mechanism, physiological consequences, and approaches to make SDS is reviewed. An in vivo method of extended glycemic index (EGI) is proposed to evaluate its metabolic effect and related health consequences.