Day 1 :
University of Florence, Italy
Time : 09:35-10:05
Mario Ciampolini is a retired professor from Università di Firenze, Dept Pediatrics, directed the Gastroenterology Research Unit, a third level referral center in the department of Pediatrics of the University of Florence (Meyer hospital) for 40 years. He worked at the Cornell University for a joined research with the University of Florence on energy expenditure in children. Three students came from Amsterdam Medical Center to learn “Recognizing Hunger” he made the first diagnoses of celiac disease in Tuscany and published 130 scientific articles, about 40 in international Press.
Background: The will to eat is a decision associated with conditioned responses and with unconditioned body sensations that reflect changes in metabolic biomarkers. The body feelings described as hunger have often components that are conditioned by time, social behavior and sight of food. Blood glucose is a biomarker of current energy availability and of hunger. Extensive rat and human studies showed that blood glucose declines coincided with spontaneous feelings of hunger, with metabolic insufficiency and meal initiation. Objectives: Investigating whether the decision to eat can be delayed until blood glucose is allowed to fall to low levels, when feeding behavior is (mostly) unconditioned. Methods: 7-week pilot study was carried out. 158 adults suffering from diarrhea, abdominal pain, and dyspepsia were recruited and randomized to experimental (trained; n=80) and control (untrained; n=78) groups. Subjects of experimental group were trained to ignore meal times and to pay attention to their earliest sensations of hunger or discomfort, so to measure glucose concentrations (blood glucose, BG) with glucometer. They were instructed to associate their sensations of hunger with BG value. The control group followed their normal routine. In the final investigative session (after compilation of a 7 days dairy) all patients were asked to estimate their preprandial BG and a blood sample was taken to measure BG through a glucose autoanalyzer. Results: At the end of the 7-week training period, estimated and measured glycemic values were found to be linearly correlated in the trained group (r=0.82; p=0.0001) but not in the control (untrained) group (r=0.10; p=0.40). Fewer subjects in the trained group were hungry than those in the control group (p=0.001). The 18 hungry subjects of the trained group had significantly lower glucose levels (80.1±6.3 mg/dL) than the 42 hungry control subjects (89.2±10.2 mg/dL; p=0.01). Moreover, the trained hungry subjects estimated their BG (78.1±6.7 mg/dL; estimation error: 3.2±2.4% of the measured BG) more accurately than the control group (75.9±9.8 mg/dL; estimation error: 16.7±11.0%; p=0.0001). In addiction the estimation error of the entire trained group (4.7 ± 3.6%) was significantly lower than that of the control subjects (17.1±11.5%; p=0.0001). Conclusion: Patients could be trained to accurately estimate their blood glucose and to recognize their sensations of initial hunger at low glucose concentrations. These results suggest that it is possible to learn a behavioral distinction between unconditioned and conditioned hunger, and to modulate intake to achieve three IH arousals per day.
Royal Free Hospital, UK
Time : 10:25-10:55
Martyn Caplin is a Professor of Gastroenterology & GI Neuroendocrinology at the Royal Free Hospital and University College London. He has published over one hundred and fifty peer review papers, written multiple book chapters and co-authored two books. He regularly lectures both nationally and internationally. From 2006-2012, he was the Clinical Lead for “NHS Evidence” for Gastroenterology and Liver diseases. He was a Member of the National Cancer Research Institute (NCRI) upper-G.I. Cancer Committee 2006-2014. He is an international expert in Neuroendocrine Tumours and is the Chair of the European Neuroendocrine Tumor Society. He has received a Lifetime Achievement Award from the UK & Ireland Neuroendocrine Tumour Society in recognition of his Clinical Leadership and Research in the field of NETs.
The recent press has highlighted that our lifetime chance of developing cancer is almost 1 in 2. The World Cancer Research Fund and the American Institute for Cancer Research suggest that most cancer is preventable, through a combination of smoking/tobacco avoidance, appropriate diet, regular physical activity and maintaining a healthy body weight. We know there is a strong link between diet and cancer, although it is very complex. Expert consensus suggests 9-40% of cancers are directly linked to diet and this risk is even greater if you are obese. Eating a healthy balanced diet that is high in fibre, fruit and vegetables and low in red and processed meat and salt can reduce cancer risk. ‘Superfoods’ with anti-cancer properties have hit the headlines and while there may be some evidence that the chemicals in these foods have positive health benefits, most of the studies have been conducted in a laboratory with limited large scale studies. The World Health Organization (WHO) the EPIC study, involving more than half a million people in 10 European countries followed for almost 15 years. The study found strong evidence that higher levels of vitamin D are associated with a reduced risk of colorectal cancer and better survival outcomes; dietary fibre protects against colon cancer; high intake of fat predisposes to breast cancer; diets high in flavonoids can reduce the risk of primary liver cancer and bladder cancer; and many more similar conclusions related to vitamin levels, diet and cancer. Other smaller studies point to the potential anti-cancer properties of a variety of diet derived chemicals including lycopene (from tomatoes), curcumin (from turmeric) and catechins (from green tea). Lycopene is a powerful antioxidant that has been linked to a reduced risk of prostate cancer, breast cancer and liver disease/cancer. Studies suggest that curcumin inhibits many of mechanisms responsible for the development of cancer and may reduce the risk of a range of different cancers including those of the breast, bowel, pancreas and liver. There are also for example clinical trials of curcumin being added to chemotherapy in the treatment of advanced bowel cancer as previous experimental studies had shown benefit of the combination over chemotherapy alone. Green tea contains high levels of catechins, which have been shown in the laboratory to prevent the activation of oncogenic pathways and block the growth of tumour cells. Consumption of green tea has been linked with a reduction in the risk of bowel, prostate and pancreatic cancers. However not all vitamins are good for you. For example selenium which may be good for pancreatic conditions can be bad for you in combination with vitamin E if you have advanced prostate cancer. People who understand the importance of good nutrition on reducing their cancer risk often seek to augment their diets by eating specific foods or taking vitamins or supplements. However if going down the route of supplementation then the appropriate dosage and bioavailability are just two of the key factors. The message that most cancer is preventable has not as yet stimulated a population reaction or political agenda.