Sylva Nova
We are never alone: billions of microorganisms (bacteria) animate our intestinal ecosystem with sophisticated intelligence, even giving us warning signals. In short, our intestine is equipped with such communication skills that it can be considered a second brain.
We discuss this topic with Dr. Stefano Bellentani, a gastroenterologist and hepatologist specialising in Food Science and Dietetics. He has worked mainly in Italy, conducting research in the field of liver disease and the epidemiology of the liver associated with lifestyle and eating habits. Formerly a full professor of Gastroenterology in Modena, in 2020 (at the age of 58) he opened his own medical practice in Locarno, after two years as a Gastroenterologist in two London hospitals and another two years at the Clinica St. Chiara in Locarno, where he is still a consultant and where he set up an endoscopy service.
He is the author of over 150 reviews and scientific articles. Among the most interesting research projects that have made him internationally famous is the Dionysos project, an in-depth study which, although carried out for other purposes, anticipated the current literature on the microbiome.
Dr. Stefano Bellentani: Yes, in 1991 I conceived a major epidemiological research project called ‘Progetto Dionysos’, which was carried out over more than 15 years. This resulted in extensive health screening of all citizens involved in the experiment, residing in Campogalliano (Modena) and Cormons (Gorizia). Essentially, important information was gathered on the relationship between viruses, bacteria, diet and liver disease. The project is unique in the world. Over the last 20 years, the scientific results of this work have not only had an impact on daily clinical practice in terms of the prevention and treatment of liver disorders, but have also been presented at major scientific conferences and published in the most renowned scientific journals in the field. The comparison between the two provinces under study – which differ mainly in terms of diet – can now also be interpreted in relation to the microbiome (microbiota), which was misunderstood at the time.
If for years, perhaps centuries, the link between health and the digestive system – in particular the universe of microorganisms that colonise the intestine – has eluded scientific observation, what was the turning point?
– Obviously, research and sophisticated laboratory investigation methods have helped to turn the page, even if knowledge of the microbiome cannot be limited to the mere identification of microorganisms, but it is necessary to understand how to keep them in balance. If stability is disrupted, health can be compromised. Our immune system is largely represented by the gut. All our bodyguards are enclosed in the gut, which, if unrolled, covers a football field…
What about laboratory tests?
– Although microbiome research will continue to improve in the future, we can already perform accurate molecular analysis of the microbiome through faeces. With a simple gesture, the patient collects a stool sample and sends it directly to the laboratory at their own expense. Subsequently, based on the laboratory results, the doctor takes appropriate action, both in maintaining health through, for example, diet and appropriate lifestyle choices, and by intervening with prebiotics and/or probiotics when the balance is significantly disturbed.
Diet and lifestyle are the cornerstones of your new project, which came to fruition in the summer with the creation of the Lifestyle Medical Clinic. This is a first in Ticino and Switzerland, based in Locarno. Is this a new paradigm in your career?
– It is a project dedicated to patients who need to change their lifestyle, carried out in collaboration with my team at the Integritas clinic and my colleagues. Lifestyle Medicine is a new branch of internal medicine that takes a holistic approach to patient care and is headed by family doctors. It is a return to the origins of the medical profession, a reversal of the trend of recent decades, characterised by overly specialised medicine, in which patients are treated by various specialists who deal with each individual diseased organ, but the patient is rarely considered as a whole ‘person’. A new paradigm? Rather, it is the culmination of years of dedication to medicine and patients. My role at the Lifestyle Medical Clinic is to coordinate the entire healthcare team and plan both the healthcare of our patients through an initial consultation with accurate and innovative diagnostic tests and a course of treatment and follow-up checks to be undertaken with the patient. In addition, we will soon be launching research into the microbiome and autism in adults.
The documentation relating to Dr Bellentani’s new multi-specialist medical project clearly highlights the interconnection between the various disciplines that characterise the clinic: from gastroenterology to dietetics, from psychiatry to psychotherapy, from physiotherapy to nutrition, as well as personalised physical activity, anti-smoking therapy and other addictions, and, last but not least, a particular focus on the microbiome. Certainly, by now the microbiome fascinates us. We have come to understand that our gut is no longer treated by science as ‘cat food’ or a central sewage plant; we now know that gut health is fundamental to our physical and mental well-being, that the microbiome is intelligent and creative. In short, we have sufficient evidence to consider it a precious gallery of contemporary art.