Poi-Based, Low-Allergenic, Cultured Foods for the Possible Prevention and Treatment of Gastrointestinal Concerns


Pamela Noeau Day

The Problem

Gastrointestinal disorders and diseases, food intolerance and allergy, and the severity of symptoms and death resulting from these disorders affect millions of people worldwide. 

Current awareness of disease resulting from micro-ecosystem imbalance, emergence of pathogens resistant to antibiotics and with enhanced virulence, clinical conditions recalcitrant to conventional treatment, and awareness that some infections and disorders lead to serious sequelae demonstrates that a critical need exists to help solve these problems.

The current state of the art—which includes the use of probiotic cultures often delivered in capsule or allergic form and/or delivering viable bacteria without the full array of by-products, bacteriocins, and compounds created during the natural fermentation process—does not address the critical need discussed above. 

Probiotic bacteria and associated by-products created during the natural fermentation process, combined with low-allergenic, nutrient-dense, easily digested foods may aid low risk protection from infection and disease and is required to assist those people with gastrointestinal disorders and diseases.  It is proposed that hypoallergenic, easy to digest, naturally cultured poi, addresses the problem of how probiotics and nutrition is delivered to patients and could solve the critical need.


The Need

Research suggests that probiotic bacteria may mediate a variety of health effects for two of the most vulnerable subgroups of the population, children and the elderly, due to the many purported and widely researched benefits attributed to probiotic cultures.

In the United States, each child will have had 7-15 episodes of diarrhea by the age of 5 years, 9% of all hospitalizations of children less than 5 years old are associated with diarrhea, and 300-500 children die each year from this potentially preventable condition.1 Antibiotics may make children sicker when given for diarrhea. Children who got antibiotics for diarrhea caused by E. coli 0157:H7 had a 17 percent greater chance of getting hemolytic uremic syndrome, a severe, life-threatening kidney and blood disease.2 Dr. Josephine P. Briggs, a kidney specialist and director of kidney research at the National Institute of Diabetes and Digestive and Kidney Diseases states that, these studies are reminders “to be cautious about using antibiotics and a warning about using them in children with diarrhea.” 

The most common alteration of intestinal flora in children occurs with antimicrobial therapy, especially with broad-spectrum antibiotics.3 Because children receive antibiotics rather often and are quite prone to gastrointestinal disease in the first few years of life, use of probiotics in children remains an area of significant interest and research.4

Diarrhea is a major cause of morbidity and mortality in the elderly due to infection, food allergy and sensitivity, and antibiotic use.5

Digestive disorders and food sensitivities affect over half of the American population, whether chronic (20 million), acute (14 million) or intermittent (100 million).6 Infants are the most likely to develop food allergies that can translate into life-long problems.7 Cows’ milk allergy appears to be among the more prevalent food allergies in infants and children followed by eggs, soy, wheat, and peanuts.8 Milk and soy are two of the top eight foods that account for 90 percent of all food-allergic reactions.9

Lactose intolerance and other food sensitivities tend to worsen with advancing age and is often more common and more severe among the elderly.10Symptoms of IgE-mediated food allergies can include nausea, vomiting, diarrhea, abdominal pain, colic, urticaria, eczema, or atopic dermatitis, angioedema, pruritis, rhinitis, asthma, laryngeal edema, anaphylactic shock, and hypotension.11 Weight loss, malabsorption, bacterial overgrowth syndrome, pernicious anemia, gastric atrophy, dental and oral disorders, sensation of flavor from food, and malnutrition are common among the elderly.12

Current statistics from the Celiac Disease Foundation indicate that celiac disease, a severe digestive disorder triggered by gluten in wheat and other grains, affects more than 1.5 million people in America.13 The treatment of celiac disease involves the avoidance of wheat, rye, barley, triticale, spelt, kamut, and oats and products made from these grains.14 The use of even rice and soy beverages and products are discouraged for those with celiac disease because of the use of barley enzymes in their production process.15

Autism is a complex developmental disability that typically appears during the first three years of life. The result of a neurological disorder that affects the functioning of the brain, autism and its associated behaviors have been estimated to occur in as many as 1 in 150 8-year-old children in multiple areas of the United States.16 A report from the California Department of Developmental Services states “autism is and will most probably continue to be the fastest growing disability served by the regional center system.”17

Allergies and food sensitivities are beginning to receive much attention as possible contributors to autistic behaviors. Many families have observed rather dramatic changes after removing certain food items from their children’s diet. Researchers have recently detected the presence of abnormal peptides in the urine of autistic individuals. It is thought that these peptides may be due to the body’s inability to breakdown certain proteins into amino acids; these proteins are gluten (e.g., wheat, barley, oats) and casein (found in human and cow’s milk). Many parents have removed these substances from their children’s diets and have, in many cases, observed dramatic, positive changes in health and behavior.18

In addition to a gluten-free diet, probiotics have been advocated as a suitable treatment for autistic symptom alleviation, and it is now appropriate to assess the extent and mechanisms of their effectiveness.19

The equilibrium of the intestinal flora is an important factor in maintaining the host’s good health.  This is particularly true of neonates, children, and the elderly whose immune systems can be underdeveloped or compromised, in whom food allergies and sensitivities can be most prevalent, and in whom drug treatment, changes in diet, and stress may have a considerable effect on that equilibrium.20 Disruption of the delicate balance of the gastrointestinal tract can contribute to diarrhea (e.g., antibiotic-associated diarrhea, traveler’s diarrhea, intestinal infections), gastroenteritis, constipation, irritable bowel syndrome, inflammatory bowel disease (e.g., Crohn’s disease and ulcerative colitis), food allergies, and certain cancers.21


Proposed Mechanisms of Action of Probiotics

Several mechanisms of action are thought to influence the effectiveness of probiotics. Probiotics may stimulate production of compounds that inhibit or destroy pathogens.  Selected probiotic lactic acid bacteria (LAB) have been shown to elicit beneficial health effects particularly in humans. Competitive exclusion of pathogens is one of the most important beneficial health claims of probiotic bacteria. The effect of probiotic LAB on competitive exclusion of pathogens has been demonstrated in humans, chickens, and pigs.22

They also may act to lower intestinal pH by stimulating lactic acid, producing organisms that favor growth of more beneficial organisms. It is thought that the adhesion properties of the Lactobacillus species, as well as their production of bacteriocins, hydrogen peroxide, and biosurfactants, are particularly beneficial.23

It is also well known that beneficial intestinal bacteria are involved in intrinsic production of certain B vitamins and folate.  Probiotics have traditionally been thought to be useful in the treatment of various gastrointestinal diseases. Lactic acid bacteria, in particular specific lactobacilli and bifidobacteria species, are among the most widely used and studied probiotics.24


Food Fermentation

Food fermentation is a process in which raw materials are converted to fermented foods by the growth and metabolic activities of desirable microorganisms.  The United Nations Rome Report of 1999 assessed that “Fermentation is the oldest known form of food biotechnology” and, fermentation of food causes “enrichment of nutritive content by microbial synthesis of essential vitamins and improving the digestibility of protein and carbohydrates.”25 The following will examine the substantial tradition and science supporting the use of fermented and probiotic whole foods for the nourishment of humankind.

While many of the benefits of fermented products may derive from the presence of viable probiotics in food, many important health benefits of fermented foods that have been pasteurized, or otherwise do not deliver live probiotic bacteria, have been scientifically validated.26 These health benefits are derived from the numerous compounds that are created during fermentation that may include anti-allergenic effects;27 and anti-mutagenic properties,28 along with conversion of food substrates biologically into vitamins, protein, essential amino acids and essential fatty acids.29

DNA from probiotic bacteria has been shown to limit epithelial pro-inflammatory responses in vivo and in vitro.  Evidence also has been presented that intestinal epithelial cells may have evolved a strategy to distinguish between pathogenic, commensal and probiotic bacteria based upon a bacterial DNA fingerprint.  While research is required to further substantiate these studies, this represents one potentially important mechanism by which probiotics may elicit immunomodulatory effects. It was recently suggested by scientific research that it is not necessarily the presence of live culture that leads to possible beneficial effects of fermentation and probiotic bacteria.30


The Opportunity

The crucial need to provide less allergenic, probiotic foods especially for a vulnerable segment of the population, children and the elderly, creates an opportunity to address those needs utilizing poi, an indigenous, traditionally fermented, culturally valuable food staple of the Hawaiian people. 

Traditionally, the marvelous physical development of Hawaiians has been attributed to poi  (Pre-Western contact).31 It is an excellent carbohydrate source with 27 grams of carbohydrates based on 100 grams portion of edible sample (USDA, 2001). The starch in poi is composed of small granules and is extremely digestible. In Hawaii, poi traditionally was and currently is used for infants and children suffering from malnutrition and food allergies. The benefits of poi in preventing allergic disease in potentially allergic infants and children have been demonstrated.32

Cooked taro corm that is blended, mixed with water, and fermented is called “poi.”   The making of poi is indigenous to Hawaii and is the only place in the world where this ancient practice of food preparation is still found as a mainstream cultural and spiritual experience.  For centuries, taro (Colocasia esculenta) has been a nutritious staple food for Hawaiians and many other Polynesian peoples throughout the Pacific Rim.  The use of poi as a staple is believed to have led Captain James Cook and other early western visitors to Hawaii to describe native Hawaiians as being an exceptionally healthy people, characterized by splendid physique and good teeth (Price, Weston A, DDS).  Scientific studies have substantiated this observation.33

In Hawaiian culture and around the world, poi can be used as an excellent substitute for dairy, soy, and grain products. It is proposed that poi may be successfully used by people with food allergies, food sensitivities, autism, celiac disease, and various other health conditions that require a low-allergenic, easily digestible, probiotic food source. 34

Studies have shown that poi is a hypoallergenic,25 naturally fermented, energy dense, carbohydrate staple that contains heat-resistant lactic acid bacteria (LAB).36 Despite having an acidic pH, which enhances food safety, poi and taro are considered alkaline foods because the alkaline-forming elements (Na, K, Ca, Mg) that are present exceed the acid-forming elements  (S, P, Cl).37 Thus, poi acts as an alkalinizing food in the body rather than an acidifying food.  This characteristic helps explain why poi is regarded as a food that can prevent dental caries and why it is highly digestible,38 and suggests its use in offsetting the tendency toward acidity in advanced cancer patients. 

It is suggested that low-allergenic, energy-dense, nutritious, probiotic foods made from poi, the fermented paste of the taro corm, could be useful in the management of dietary concerns of children and the elderly, as well as in the general populace.   Poi’s use in low-allergenic foods, taking advantage of its unique combination of low allergenic protein and promising probiotic activities, should be investigated for benefits to patients affected by certain medical conditions.

Foods made with highly allergenic dairy, soy, and grain ingredients are widely available to the public.  Foods formulated with low-allergenic ingredients, containing hypoallergenic poi and viable probiotic cultures are practically non-existent; and these could provide a much needed, nutritious and valuable alternatives for those with special dietary needs, especially the high-risk populations of children and the elderly.  Poi-based products should be more suitable for minority populations than yogurt due to a higher incidence of lactase deficiency among minorities.

Clearly, food that has sensory appeal, (e.g., utilizing a variety of tastes, textures, aroma, and color) and that acts as a transport system for probiotics, and physiologically functional compounds and nutrition, may be particularly preferable to children and the elderly due to their difficulties in swallowing pills or ingesting substances that are not appealing to the senses.  In addition, the natural buffering of stomach acid by the food carrier could enhance stability of the probiotics after consumption.


Innovation and Summary of State of the Art

The proposed work is innovative because Taro Dream Inc., Bio-Native Nutrition is the first company to create, with encouragement and permission from the foremost Hawaiian Healers, a probiotic, value-added product from the Hawaiian’s premier food staple – Taro and Poi.  The company is the first to isolate and identify the most beneficial lactic acid producing bacteria from poi for the purpose of creating foods for special dietary use, digestive conditions, and management of certain medical conditions.  The use of poi as a delivery system of probiotics and low-allergenic nutrition in a delicious, easy to consume form, is the novel and innovative approach to this proposed project.

It is our expectation that the usage of select poi cultures will dramatically improve the manufacture of this fermented food to obtain a highly desirable, consistent, pure, and standardized product.  Select poi cultures that are naturally fermented to create the critical, beneficial compounds and bacteriocins will be combined with nutritious, antioxidant-rich tropical fruit and other low allergenic ingredients, which have been heat sterilized—creating a consistent, safe, and predictable probiotic food. 

These results will be significant because they will provide new plant-based products that will act as basal therapeutic interventions for a variety of health conditions.

This project advances scientific knowledge through

  • The identification of new plant-based, potentially powerful, medically safe, acid-stable, lactic acid starter cultures for use in medical foods; 
  • Exploration of a natural, culturally significant resource for a functional ingredient (e.g. poi);
  • Identification of a new target to better cope with the multiplicity of symptoms of modern human beings and basing this on nutritional and scientific findings;
  • Employment of innovative technology for development of consumer-friendly foods to assist in the physiological state (e.g. probiotic deficiencies, food allergies and problems associated with food allergies, digestive disorders and associated diseases) and;
  • Utilizing a unique food (e.g. poi) and combining it with other low allergenic ingredients to act as a delicious delivery system for beneficial LAB cultures, physiologically active fermentation compounds, and general nutrition that is more bio-available due to the unique components of poi discussed above.


Technical Challenges

One of the greatest challenges to the commercialization of poi-based products is shelf life.  Poi historically has a shelf life of 3 to 5 days.  Through research, the company has developed methods, which extended the shelf life of the product to the equivalent of yogurt.  However, the viability of the probiotics in the product over that time is not known. In order to produce an effective probiotic food, the probiotics need to remain viable both during the shelf life of the product and through gastric transit. Probiotics must survive the digestive processes of the stomach in order to be effective in the intestine. The first step in achieving this goal is to select probiotics that have the potential to be resistant to high acid and high bile salt concentrations. 

The microorganisms selected for additional study have been isolated from naturally fermented poi and are members of genus and species considered to be probiotics.  The use of these organisms is attractive because they enhance nutrition and produce acid that helps preserve the product.  Some probiotics produce levels of acid that inhibit the growth of many spoilage organisms and/or potentially dangerous pathogens (Gasson, M 1993, Nes, I.F. 1993, Piard, J.C., Desmazeaud, M. 1992, Vanderbergh, P.A. 1993).

In addition, some probiotics produce metabolites that act as food-grade additives.  Although the production of metabolites by the isolates being considered is not known, this is an appealing alternative to chemical food preservatives and an added benefit to including certain probiotics. The inhibition spectrum for known lactic acid bacteria (LAB) metabolites includes both Gram-negative and Gram-positive bacteria (Gasson, M 1993, Nes, I.F. 1993, Piard, J.C., Desmazeaud, M. 1992, Vanderbergh, P.A. 1993.).

By adding known amounts of probiotics isolated from naturally fermented poi back into poi-based food products, the company will create a nutritionally enhanced food with low allergenic potential.  In order to claim nutritional enhancement, the company has proven that the probiotics remain viable throughout the intended use of the product. The company utilizes novel, poi-based probiotic organisms that has the potential to survive during the shelf life of the product and digestive process.  


The Solution

Poi, the sacred food of the Hawaiian people, is the answer for many health conditions, especially the health issues facing the most vulnerable segment of the population, children and the elderly.

 

References

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  2. United States National Institute of Diabetes and Kidney Diseases of the National Institute of Health. News Brief, June 5, 2000, Antibiotics May Harm Children with Diarrhea. Division of Gastroenterology, Ch-24, Children’s Hospital and Regional Medical Center.
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Published May 6, 2023


About the Author

Pamela Noeau Day, founder of Taro Dream Inc. and BioNative Nutrition and Research, began her pursuit in 1988 for a hypoallergenic food out of necessity to save the life of her highly allergic infant daughter. This “staff of life” of the Hawaiian people not only saved her daughter’s life but has been the answer for thousands of people with digestive challenges, celiac disease, and food allergies.

Noeau is humbly grateful to be the apprentice of the late Po`okela Papa Henry Auwae and Practitioner of the ancient indigenous Hawaiian healing modality of La’au Lapa’au. She has almost 20 years of concentrated study and practice of Hawaiian herbal medicine, spirituality and mastery of all levels of Kahuna La’au Lapa’au. https://heyokamedicine.com/