Translated by AIVersione italiana
Key points
- The disease begins decades before diagnosis
- The claim: processed food is reshaping the microbiota
- The roadmap
4′ min read
Translated by AIVersione italiana
Non-communicable diseases cause 43 million deaths worldwide every year, yet one of their main biological factors – the alteration of the gut microbiome due to modifiable environmental factors – is still underestimated by stakeholders in the healthcare sector. There is, however, an urgent need to translate scientific knowledge about the microbiome into concrete actions involving all stakeholders: from food safety bodies to public health authorities and policy-makers. This is the analysis and appeal put forward by three generations of scientists from the Gemelli IRCCS University Polyclinic Foundation and the Catholic University of the Sacred Heart in a study published in Nature Reviews Gastroenterology & Hepatology, the world’s most authoritative journal in the field of gastroenterology.
Researchers have shown that the gut microbiota is not merely associated with chronic diseases: it actually precedes them. They have identified ultra-processed food and its industrial additives as the main culprits behind the silent destruction of the human biological ecosystem. Not only that: they have drawn up a series of concrete proposals – a road map – to reverse this trend, including through the implementation of specific health and economic policy measures. The stakes are twofold and crucial: the health of millions of people, including in Italia, as well as the sustainability of healthcare systems increasingly burdened by chronic conditions combined with an ageing population.
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The disease begins decades before diagnosis
The gut microbiota — the ecosystem of 38 trillion microorganisms living in our gut — is the most accurate diagnostic tool medicine has ever had. Not because it detects disease that is already present, but because it spots it years, sometimes decades, before it manifests itself. The mechanism is called meta-inflammation: a chronic, silent inflammatory state, invisible to standard tests, which progressively erodes the metabolism, the immune system and the nervous system. By the time a patient presents with diabetes, a heart attack or cancer, this biological fire has already been burning for some time.
“The biological markers of meta-inflammation may be detectable years, or even decades, before the disease manifests clinically. This opens up real prospects for a truly proactive, preventative and personalised approach to medicine. We don’t wait for the disease: we intercept it before it arrives,” explains Antonio Gasbarrini, scientific director of the Fondazione Gemelli IRCCS and professor of Internal Medicine at the Catholic University
The claim: processed food is reshaping the microbiota
Ultra-processed foods — which in many countries already account for more than half of the calories consumed — are not harmful to health solely because of their nutritional composition. They do so through industrial additives: emulsifiers, artificial sweeteners, preservatives and colourings that alter the gut microbiota via molecular mechanisms now documented with scientific precision. The paradox highlighted by the research is shocking: these additives have been approved by regulatory bodies — EFSA in Europe, the FDA in the United States — without ever assessing their effect on the human gut microbiome. Food safety protocols were drawn up before the science of the microbiota even existed. They have not been updated.
‘Their impact on the microbiota and the intestinal barrier is not a negligible side effect. It is a primary pathogenic mechanism. We are allowing the industrial restructuring of the human microbiota on a population scale without assessing the consequences. This must stop,” says Gianluca Ianiro, medical director of the UOC Cemad at the Gemelli University Hospital Foundation (IRCCS) and a researcher in gastroenterology at the Catholic University.”
‘What the science of the microbiota is revealing today – namely that health is a property of the ecosystem, not just of the organism – is the most profound conceptual revolution I have encountered in sixty years of clinical practice and research. It is not a hypothesis: it is the biological reality that was waiting to be measured,” continues Giovanni Gasbarrini, Professor Emeritus of Internal Medicine at the Università Cattolica del Sacro Cuore
The roadmap
The research does not stop at highlighting the problem. It sets out a call to action based on five pillars:
1. Education — reforming nutritional literacy by incorporating the science of the microbiome, starting in schools
2. Agriculture — restructure agricultural subsidies to encourage the production of fresh and minimally processed food
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3. Healthcare — introduce antibiotic stewardship with metrics for microbiome protection; launch structured programmes to reduce the prescribing of proton pump inhibitors
4. Economy — tax food additives with proven dysbiotic potential; reimburse microbiome-based prevention programmes
5. Research — establish dedicated public funding schemes for research into the relationship between the microbiome and chronic diseases, involving longitudinal cohorts and intervention trials
“We call for the safety assessment of food additives to include standardised evaluations of the microbiota. We call for the effects of additive mixtures to be assessed in a real-world context. And we call for an end to the separation between nutritional regulation and food safety: you cannot declare a food safe by looking only at macronutrients and ignoring its impact on the gut ecosystem’, warns Antonio Gasbarrini. He adds: ‘The gut microbiota is the most accurate biological mirror medicine has ever had. Today, it paints an alarming picture: millions of preventable deaths every year, children whose gut ecosystem is already compromised before they even start school, and a regulatory framework that has allowed all this to happen without ever measuring the consequences. Despite a decade of well-established scientific evidence, the medical profession and policymakers have still not responded. The era of ecological medicine must begin now — not to produce new science, but to save lives.”
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