An Italian study reveals how an altered microbiome anticipates the onset of chronic diseases. Scientists highlight the potential for prevention and call for new regulations on ultra-processed foods.
The gut microbiota, the community of microorganisms that inhabit our intestines, is a "biological mirror": through its condition, it may be possible to anticipate chronic diseases in the body many years before symptoms appear.
This is the finding of a study published in Nature Reviews Gastroenterology & Hepatology by three generations of scientists from Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica del Sacro Cuore in Rome: professors Antonio Gasbarrini, Gianluca Ianiro and Giovanni Gasbarrini.
By the time diabetes, cardiovascular disorders or tumours are diagnosed, some of the biological processes that caused the disease may have been under way for years. This state is defined as meta-inflammation — chronic, silent and invisible to standard tests. "The biological signatures of meta-inflammation could be detectable years, or even decades, before the disease manifests clinically," explains Antonio Gasbarrini, Scientific Director at Fondazione Policlinico Universitario A. Gemelli IRCCS in Rome and Full Professor of Internal Medicine at Università Cattolica del Sacro Cuore in Rome. "This opens up concrete prospects for a truly anticipatory, preventive and personalised medicine. We don't wait for the disease: we intercept it before it arrives."
The gut microbiota, therefore, is not merely associated with chronic diseases: it anticipates them. "I watched this discipline come into being," says Giovanni Gasbarrini, Emeritus Professor of Internal Medicine at Università Cattolica del Sacro Cuore in Rome. "What microbiota science is revealing today — 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. This is not a hypothesis: it is the biological reality that was waiting to be measured."
The scientists go on to explain that one of the main causes of microbiota disruption is the consumption of ultra-processed foods, which damage the health of the body and the gut not only through their nutritional composition but also through their high content of additives such as colorants, preservatives, emulsifiers and sweeteners. For this reason, the study raises the alarm about such foods and calls on regulatory bodies to revise the rules governing the presence of additives in food, in light of the most recent discoveries about the microbiota and its connections to metabolism and the nervous and immune systems.
"The impact of additives on the microbiota and on the intestinal barrier is not a negligible side effect. It is a primary pathogenetic mechanism," explains Gianluca Ianiro, Medical Director of UOC CEMAD at Fondazione Policlinico Universitario A. Gemelli IRCCS and researcher in Gastroenterology at Università Cattolica del Sacro Cuore. "We are allowing the industrial restructuring of the human microbiota on a population scale without measuring the consequences. This must stop."
"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 the separation between nutritional regulation and food safety to be overcome: a food cannot be declared safe by looking only at its macronutrients and ignoring what it does to the intestinal ecosystem," adds Antonio Gasbarrini.
Chronic diseases cause 43 million deaths every year. To prevent these deaths, the scientists argue it is urgent to translate scientific knowledge about the microbiota into concrete actions involving all relevant stakeholders, from food safety bodies to public health authorities and policymakers. The research proposes a call to action built around five pillars:
