You discussed sustainable and personalized nutrition in a recent review article. You talked about precision nutrition that forms part of precision medicine. What is precision nutrition, personalized nutrition? How to make global nutrition sustainable?

I must confess that 'precision nutrition is a little bit a [fashion]. This term was developed in this field because now it is very fashionable. But certainly, I would say that the term 'personalized nutrition' is probably more understandable. That's what everybody with an illness or also with risk factors does. The sense that we all tend to modify nutrition, particularly ill people or the people at risk of disease. But also, healthy people tend to modify their daily diet, depending on their risk factors. For instance, I will say, I will make you an example. Yesterday, I saw a person in my private practice. It was a 60-year-old person who was very healthy. He had no problem. But he has some laboratory tests that indicate that he has a risk of metabolic syndrome. He has very high cholesterol, borderline high levels of uric acid and blood sugar. So he has, in a sense, an early phase of the metabolic syndrome. This guy did understand that this was a problem. And so, whereas he was used to calling me from a region of Italy, where the food is mainly based on animal food or meat. They are big consumers of meat. He moved over to a quasi-vegetarian diet. This is a typical example, in my opinion, of personalized nutrition.

I said, but I am really, truly vegetarian, he say, with some exception, because for instance, I ate fish occasionally, which is a good thing. But, uh, he did decide himself to do this. So which is exactly, I could only say very little. He also does a lot of exercises, 10,000 steps every day. So that's a typical example of how primary prevention is very effective, even in people with some risk factors. Their risks are probably inherent in their inheritance because cholesterol is mainly due to inheritance rather than a diet. So, that is the situation of personalized nutrition. It is a typical example of personalized nutrition. This guy is right in choosing to eat a lot of vegetables, a lot of fruit, and reducing dramatically the consumption of meat or processed food. And instead, he is using a lot of fish. This is also not only about precision, or personalized nutrition, which of course, is easy to understand. It is a problem of sustainability.

Because the globe is expanding, very soon there will be 10 billion people. And then the sources of food are becoming very precarious. It is also because to provide food, even vegetable-based food, you have to destroy forests, which is the problem in Brazil, the problem in India and China, in Indonesia. Even though I would say, particularly in China, at least in principle, people have learned. And now people are increasing forestation in their own country, which is not happening, for instance, in Brazil. And this also applies to our countries, European countries, maybe not in your original country, Russia. But I'm sure that in some parts of Russia, this is also a problem.

So what I learned in my relatively recent interest in nutrition is this. What matters is not so much the composition of the food. Carbohydrates, sugar, fats, and proteins are not in themselves the culprit. So it is not worth looking at the composition of the food. Because you will find that in food that there is a lot of carbohydrates. Carbohydrates are dangerous only when they are sugar. That gives a rapid increase of glycemia, a very high glycemic index. But there are also carbohydrates in very good food, like vegetables, like fruit. And these are not detrimental. So a way to look at the composition of the food [on a food label] which is provided for many foods that you buy at the supermarket is ridiculous.

What is important is what we eat. So it is a macro composition of what you eat. And then it depends on whether or not what you eat is processed or not. It is so because it is the processing more than the ingredients that make the dangers of the food. Because for instance, the processing leads to the oxidation of cholesterol, oxidation of oils, which are not in itself dangerous. But the oxidized products of phenols, cholesterol, in a sense, are those that are dangerous. So what is important, again, is to have a healthy diet, the diet based on the source of food. It is important to avoid as much as possible the processed food and to avoid the excessive consumption of meat because of the risk of cancer. You have to look at more than what is written about the composition of the food. Look at the nature of the food, the source of the food, the micronutrients.

It is not easy to explain. But for the sake of an example, I will make you an example. If you go to Greece, or Turkey, they eat a lot of yogurts, and their yogurt is very fat. And, of course, if you have high cholesterol, you think that this is not good for you. It is not true. If they are yogurt, as the name in Turkey, I think it's kefir [ayran] or something like that. Even though it is very, very fat, it is good fat. Whereas, if you eat the yogurt processed in our country, this is very highly processed. It contains probably less fat, but it also contained some ingredients that are being used to preserve it. And it has been shown, for instance, that Greek yogurt and Turkey yogurt that contain a lot of fat is not dangerous, even for people who have diabetes or high cholesterol, who have metabolic syndrome. So this gives you an example. For instance, there is a tendency to consider as a culprit fat, butter, a palm oil. Many biscuits contain Palma oil. Palm oil in itself is not dangerous; it is how it is processed that is dangerous. The palm oil has a problem because in Indonesia, to raise the palms that produce il, they destroy the forest, for this and other matters. But palm oil by itself is good vegetable oil. Olive oil is very good. But it's very difficult to nurture the population of the globe on olive oil because it grows only in certain parts of the planet. It is very difficult to have large quantities of olive oil. And the same applies to other vegetables. So again, I want to emphasize that what matters is how the food is processed and how it is given to you when you eat. So the source of the food rather than the composition of the food [is what matters most].

In terms of 'precision nutrition, which is probably more precisely called 'personalized nutrition, I will give you an example. You should not avoid at all using meat. But there are other sources of protein. You should consider meat an enemy. But you should not also consider carbohydrates an enemy because they represent inevitably an important source of our diet. And the same applies to fats. It's a matter of how the food is processed and how the food is supplied to you. And of course, it is a matter of the sustainability of the production of food. So the problem in the future is going to be this. The planet will have 10 billion people. So there will not be enough food for everybody. That is a big problem that should be tackled by those who are dealing with the problem of climate change.

For instance, let's go into the issue of climate. The animal factories and extensive agricultural cultivation is not considered [usually] as a source of pollutants. And probably they are less important. We will discuss later the 2.5-micrometer particles (PM2.5), ozone, and nitric oxide. Animal factories are certainly also a source of pollution because they produce ammonia. And ammonia is an important component of pollution. It is probably less important than particles. So that together, the problem is that the world is an integrated system. It is very difficult to tackle the problem from a sectorial view and not from an all-integrated point of view. I am very keen to deepen my knowledge in this field. But altogether, the main message is that personalized nutrition applies to the risks of the population, that there is no culprit food, but the diet must be balanced. And one must certainly watch the consumption of red meat. Let us avoid very processed food and very processed carbohydrate, like Tiramisu or things like this. Of course, occasional consumption will not create any problem. So that is what I can tell you. I know that is not a very scientific message. But again, I'm not particularly an expert. I learned a lot in this field, which, together with polypharmacy and air pollution, is one of my interests in the last and thrombosis. I'm still a curious person, as you have probably noticed.

Thank you. Thank you, Professor Mannucci!