Human Nutrition from the Gastroenterologist’s Perspective: Lessons from Expo Milano 2015

218 Pages·2016·3.927 MB·English

by  Enzo Grossi, Fabio Pace (eds.)

Human Nutrition
from the
Gastroenterologist’s
Perspective
Lessons from
Expo Milano 2015
Enzo Grossi
Fabio Pace Editors
Foreword by
Reinhold Stockbrugger
123
Human Nutrition from the
Gastroenterologist’s Perspective

Enzo Grossi (cid:129) Fabio Pace
Editors
Human Nutrition from
the Gastroenterologist’s
Perspective
Lessons from Expo Milano 2015
Foreword by Reinhold Stockbrugger
Editors
Enzo Grossi Fabio Pace
Villa Santa Maria ASST Bergamo Est
Research & Development Gastroenterology
Milan Seriate (BG)
Italy Italy
ISBN 978-3-319-30359-8 ISBN 978-3-319-30361-1 (eBook)
DOI 10.1007/978-3-319-30361-1
Library of Congress Control Number: 2016940504
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Foreword
Macro-cosmos, Women and Men, Micro-cosmos: A Preface
The World Exhibition in Milano in the year 2015 has not only been a public, touristic,
and economic success for the country, but has also given the opportunity to bring into
sharp focus a fi eld not always recognized as the spearhead for Italian epidemiological,
medical, and biological research. Certainly, many tourists and travellers visit the
country to satisfy their culinary tastes, and there is presently a worldwide boom of
Italian and Italian-like restaurants. However, few people can imagine that the pleasure
of creating good food and drink in this country is paralleled by a great invention, pro-
duction, preparation, and the consumption of these products in delightful environ-
ments that can increase the sensual pleasure of ‘nutrition’ (what a poor word for the
pleasure of a beautiful evening in a stylish restaurant or a pittoresque terrace).
H owever, the exhibition has also given the opportunity to demonstrate our role as
clinical and/or scientifi c gastroenterologists in this context under the most varying
aspects. This multiauthor publication, very actually designed and edited by my
friends Enzo Grossi and Fabio Pace, leads us through the various areas of our pro-
fessional involvement with ‘nutrition’ and may in the conclusion allow me some
suggestions for an even tighter engagement in the fi eld, not only aiming at a better
service for patients and society, but also for a continuing penetration into the above
quoted macro- and micro-cosmos and its inhabitants.
When ‘Nutrition’ Causes Disease
E xactly 100 years ago, lack of food, bad politics, and subsequent global wars have
been the most prominent causes of incidence and prevalence of death. Who could
imagine that in these days over- and mal-consumption of food have taken the pri-
mary places at epidemiological mortality statistics. The landscape of global medi-
cine has changed, and nowadays cardiovascular, oncological, and gastrointestinal
disciplines are the most consulted medical players in the game. Not for nothing do
fi ve of the 13 articles in this volume refl ect this historical change that not only
touches the rich – so-called developed – countries, but also increasing segments in
countries where exact statistics still are lacking.
v
vi Foreword
I still remember that friends and colleagues laughed at me when I some decennia
ago proposed the idea that GERD and obesity seemed to be connected with each
other. Nowadays, the global advancement of PPIs is based on this correlation and
gastroenterologists are helped by oto-rhino-laryngologists to promote that reality.
O ur specialist partners, the hepatologists, can make a good living from the fatty
livers and the more or less useful therapeutic measures that can be proposed, from
life-long pre-/probiotic prescriptions to increasingly adventurous surgical
applications.
And fi nally, a long and sumptuous life with the wrong hyper-caloric habits and
diets claims its toll with malignancies in the esophagus, liver, pancreas, and colon
(only to mention our own gastroenterological/oncological territory).
How Nutrition Influences Human and ‘Micro-cosmic Biology’
We live in an exiting phase of human redefi nition: we are no longer alone with our
sorrows, alerts, intelligence, activities, and moods: we have found powerful partners
(brothers and sisters?; servants or masters?): the gut microbiome, probably more
diversifi ed and stronger and possibly ontogenetic older than we ourselves, that func-
tion as their home and feeding company. Previously, the disciplines of ‘microbiol-
ogy’ and ‘infective diseases’ were concerned with them; nowadays, every medical
branch, either in research or in clinics, has to learn to know this newly discovered
partner and must care about recognition, collaboration, and hopefully friendship
with him/her/it/them.
I n this volume, three articles deal with the gastrointestinal microbiome – our
alter ego – and its infl uence on obesity, neuro-psychiatry (autism), and the way how
we develop to ‘tasters’ and ‘super-tasters’. Will it surprise you that we have got a
fl ood of new scientifi c fi ndings (but unfortunately still a lack of remedies) in our
new daughter-discipline ‘neuro-gastroenterology’ that hosts ‘gut microbiota’
research in journals and congresses worldwide? Apropos, in this context: did you
know that long-term use of ‘PPI’s profoundly changes the ‘gut microbiome’? If not:
on PubMed there are nine hits since 2014!
Nutritional Modifications As Therapy?
T his is for the practicing gastroenterologist, internist, and surgeon probably the
most asked question by patients and relatives. The answer is ‘yes, but …’: There are
very few diseases that really can be defi nitely healed by a specifi c diet; however,
dietary interventions can limit and decrease the symptomatic impact in disorders
where a biochemical and/or anatomical defect is present and well defi ned. A peptic
stenosis in the esophagus or any subsequent gastrointestinal structure needs a liquid
or very well-chewed diet, chronically; the diarrhea of chronic pancreatitis may ask
for fat-reduced diet, and – certainly – coeliac disease does not like gluten; however,
also after decennia of gluten-free diet, a coeliac will not be healed and can relapse
at dietary failure!
Foreword vii
T ake the new kid on the block – FODMAPs – so well described in this volume:
the patient has the choice: either to continue with wrong dietary habits or to dimin-
ish/abolish the symptoms with an adequate and not too diffi cult to keep diet.
W hy do I mention all this? Haven’t we enough dieticians to advise the patients?
It might be, but in many cases a referral costs and also requires a new anamnesis by
the dietician. It can also happen that the dietician would not recognize the entire
pathogenesis and pathophysiology of the specifi c patient as well as the referring
physician who has already obtained all relevant data.
I advise in this context what I have learned to practice myself: to identify the
individual pathology and pathophysiology, to insert into the puzzle the present
dietary habits of the patient and his social surroundings, and give a few relevant and
clear – sometimes even strict – rules to the patient to be followed and thereafter to
see the patient back after a medium-long pilot period. In this way, some referrals to
a dietician might have become unnecessary and your own value has risen in the eyes
of this patient.
Certainly, it is necessary that we are able to teach students and specialist fellows
completely in this matter and that we also discuss such aspects seriously with family
practitioners, who are asked by the same patients once more.
And Now the Italian FINALE: Can the Mediterranean Diet
and the Mediterranean Wine Save the Mediterranean
and Extra-Mediterranean Humanity?
Who will really know? Yes, there are some very suggestive data. But has there
really been a valid, large, controlled study on this, putting into the accountancy all
positive and negative confounding factors from environment, genetics, and other
life modifi ers? Wouldn’t it be worthwhile to do these experiments (Italian food and
wine industry could sponsor them) and to report the results at the opening of the
next World Exhibition in Dubai, 2020? This would make people remember the
beautiful event in Milan 2015 and might add power to specialists’ knowledge and
dietary advise.
Maastricht, The Netherlands; Ferrara, Italy Reinhold Stockbrugger
March 3, 2016

Pref ace
Gastroenterology and the science of clinical nutrition share many pathophysiologi-
cal and research interests. From this perspective, the idea of publishing a multiau-
thor text where both gastroenterologists and dietitians join together is not a surprise.
What is new is the stimulus that has made all projects starting, i.e., the Universal
Exposition held in Milan, Italy, in 2015 and devoted the theme of nutrition
worldwide.
The theme of the 2015 Expo in Milan, “Feeding the Planet, Energy for Life,”
addresses a crucial issue for all countries of the world and has a double meaning: on
the one hand, to try to ensure enough food to those who live in conditions of malnu-
trition and, on the other hand, to be able to prevent new large-scale illnesses of our
time, including obesity and cardiovascular disease, valuing innovations and prac-
tices that allow a healthier life.
Will the bacteria become the key to success for a better quality of life? What is
really the role of “microbiota” on human health? The view of human beings as a
superorganism in which bacteria dominate is revolutionizing the medical knowl-
edge by introducing new concepts of disease and also suggesting possible applica-
tions in veterinary and agriculture.
T he lifestyles and critical events produce inheritable genetic modifi cation. This
is the fundamental of another emerging discipline, epigenetics, which is another
real cultural revolution.
The nutraceuticals and their impact on health is another argument in rapid evolu-
tion. The targeted use of substances naturally present in foods, taken in forms simi-
lar to those commonly used for drugs, can improve the state of health and prevent
chronic diseases. Italy is playing a leading role in this new scientifi c segment. Many
of these substances are part of the Mediterranean diet.
The Mediterranean diet is more and more put under the lens to ascertain if it is
really relevant and effective. Clarifying this aspect has been crucial for the 2015
Expo since Italy is the most important testimonial of this archetype, described for
the free time in the Cilento area, south of Italy.
W e can recover in the future a diet and a lifestyle that ensure everything you need
at our livelihood in perfect balance with our gene developed by homo sapiens in the
last 50,000 years?
Can we use this new science to prevent heart disease and cancer and prolong life
far beyond what we ever thought possible? We believe the answer is a resounding
ix