This review article explores the utilization of starch-based materials as smart materials for the removal of dyes and heavy metals from wastewater, highlighting their cost-effectiveness, biodegradability, and biocompatibility. It addresses the critical need for clean water, emphasizing the contamination caused by industrial activities, such as printing, textile, cosmetic, and leather tanning industries. Starch and its derivatives demonstrate significant potential in water purification technology, effectively removing toxicants through hydrogen bonding, electrostatic interactions, and complexation. The review also discusses the application of starch-based materials in the biomedical field, particularly as drug carriers. Starch-based microspheres, hydrogels, nano-spheres, and nano-composites exhibit sustained drug-release properties and are effective in transporting various drugs, including DOX, quercetin, 5-Fluorouracil, glycyrrhizic acid, paclitaxel, tetracycline hydrochloride, amoxicillin, ciprofloxacin, and moxifloxacin. These materials show good antimicrobial activity against a range of pathogens, including C. albicans, E. coli, S. aureus, C. neoformance, B. subtilis, A. niger, A. fumigatus, and A. terreus. While highlighting the significant achievements of starch-based materials, the review also discusses current limitations and areas for future development. Key weaknesses include the need for enhanced adsorption capacities and the challenge of scaling up production for industrial applications. The review concludes by identifying development directions, such as improving functionalization techniques and exploring new applications in water purification and drug delivery systems. This article aims to assist researchers in advancing the field of starch-based materials for environmental and biomedical applications.