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Restore Gut Homeostasis and Healthy
Weight for an Anorexia Nervosa Patient by
the Luigi Cornaro Diet
-- A Case Report --
By:
YU Bowei,
YU Boxuan,
and
YU Ligen
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Copyright © 2018 by Yu Bowei, Yu Boxuan and Yu Ligen.
All rights reserved. Printed in the Republic of Singapore. No part of this
publication may be used or reproduced in any form or by any means, or stored in
a database of retrieval system, without the prior written permission of the
publisher, except in the case of brief quotation embodied in critical reviews and
articles.
Cover photo: Dr Yu Ligen with his grandfather. His grandfather knows nothing
about diet and nutrition. Nevertheless, his consistent calm, peaceful and
undisturbed mind ensures him still actively living on himself at his current age of
103.
Disclaimers
This case report is based on the authors’ limited personal experience.
Neither the authors, the publisher, nor any other party who has been involved in
the preparation or publication of this work guarantees that the information
contained herein is in every respect accurate or complete. So this publication is
intended as reference only, and does not serve as a medical advice. The
information in this publication is only to help you make informed decisions about
your health. It is not intended as a substitute for any treatment that may have
been prescribed by your doctor, who is familiar with your specific needs. If you
suspect that you have a medical problem, we urge you to seek competent medical
care.
It is the responsibility of the readers to understand and adhere to local law
and regulations concerning the practice of the methods contained in this
publication. The authors and publishers disclaim all responsibility for any
liability, loss, injury, or damage incurred as a consequence, directly or indirectly,
of the use and application of any of the contends of the book.
First Published: Dec 2018
ISBN: 978-981-14-0181-7
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Restore Gut Homeostasis and Healthy
Weight for an Anorexia Nervosa Patient by
the Luigi Cornaro Diet
-- A Case Report --
YU Bowei, YU Boxuan, and YU Ligen*
*Corresponding Author E-mail: mlgyu@ntu.edu.sg.
*Corresponding Author Address:
Talent Recruitment And Career Support (TRACS) Office and Bibliometrics Analysis,
Nanyang Technological University, N2.1 #B4-01, 76 Nanyang Drive, Singapore 637331
Institute of Materials (East Asia)
Institute of Materials (East Asia)
Institute of Materials (East Asia)
Abstract
Anorexia nervosa (AN) is a serious health problem. Despite the highly
destructive consequences of AN, the etiology of AN is still unclear. Here we report
a case of adult male patient who developed AN by eating irregularly and fasting
for weight loss, and recovered from AN by adopting the Luigi Cornaro diet. Since
then, he has followed this diet for almost two years up to now, and he becomes
healthier than ever. For this special case, we suspect that illness/injury induced
anorexia may play a decisive role in triggering and developing AN. And AN is not
purely a mental illness, the atrophy and dysfunction in gut mucosa, and the
injury to the dysfunctional mucosa induced by improper food intake may also
contribute to the triggering and developing of AN by repeatedly triggering
illness/injury induced anorexia.
Although our patient recovered from AN by adopting to Luigi Cornaro diet,
the diet itself is not a magic remedy. Instead, we suspect that the self-healing
capacity of our body played an important role in the recovering process. Here we
propose that the upregulated autophagy is the most eminent component of our
body’s self-healing capacity, and illness induced anorexia is a manifestation of
this upregulated autophagy. Autophagy is a highly regulated process in
eukaryotes to maintain homoeostasis and deal with stress stimuli such as
starvation and pathogen invasion. Illness induced anorexia as manifestation of
upregulated autophagy will be triggered when there is acute illness (like
infection, injury or cancer) inside the human body. Illness induced anorexia is
beneficial to the host only when 1) the acute illness is not of genetic origin, and
can be rectified by upregulated autophagy in short time; 2) the host maintains a
healthy body weight, so that the health of host is not sacrificed. In the case of
anorexia nervosa reported in this book, as the acute illness is in the gut due to
starvation, the situation becomes complicated. Gut injury induced anorexia is
efficient in stopping part of the gut injury like bleeding, but the dysfunction in gut
remains, as nutrition generated by upregulated autophagy cannot reach gut
mucosa, due to the strong barrier nature of gut mucosa. So eating is essential for
the maintenance of gut homeostasis, yet eat normally is harmful to the gut when
there is dysfunction in it, and also harmful to the main body, as the nutrition
supply from food will stop the upregulated autophagy, thus will stop the self-
healing process in the main body. The maintenance of upregulated autophagy
state requires that the host follows the Luigi Cornaro diet in alleviating or curing
the gut mucosa dysfunction and restoring the gut homeostasis and the healthy
weight of the host. This means that the Luigi Cornaro diet is not a stimulus strong
enough to trigger upregulated autophagy. Instead, the Luigi Cornaro diet requires
the triggering of upregulated autophagy as a prerequisite, and it helps our body to
remain in the upregulated autophagy state, and keep away most of the common
diseases.
Keywords: Luigi Cornaro diet, Gut mucosa, Homeostasis, Healthy weight,
Illness induced anorexia, Upregulated autophagy, Anorexia nervosa, dysfunction.
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Table of Contents
Abstract
……………………………………………………………………………………………
i
Table of Contents
………………………………………………………………………………
ii
Preface
……………………………………………………………………………………………..
iii
1.
Introduction
…………………………………………………………………………..
1
2
Case
Description and Treatment
………………………………………………
1
3.
Terminologies used in this Book
………………………………………………
3
3.1.
A
utophagy
……………………………………………………………………………..
3
3.2.
Illness Induced
Anorexia and Upregulated Autophagy
……………….
3
3.3.
Gut mucosa atrophy and
dysfunction
………………………………………..
3
3.4.
Anorexia nervosa (AN)
…………………………………………………………….
3
3.5.
Food Phobia
……………………………………………………………………………
4
3.6.
Atypical Anorexia Nervosa (AAN)
……………………………………………..
4
4.
Gut protection as the most important issue for health
…………………
4
5.
Autophagy as the main component of our body’s self
-
healing
capacity …………………………………………………………………………………. 4
6.
Illness Induced
Anorexia as Manifestation of Upregulated
Autophagy Plays an Important Role in Self-Healing …………………… 5
7.
A
norexia
Nervosa as an Abuse of Upregulated Autophagy
…………...
5
8.
I
ntroduction to the Luigi Cornaro Diet [8]
…………………………………
6
8.1.
The Modified Luigi Cornaro Diet
……………………………………………….
7
8.2.
Exercise
………………………………………………………………………………….
8
8.3.
Monitor body weight
everyday
………………………………………………….
8
Postface
……………………………………………………………………………………………
8
A
cknowledgments
…………………………………………………………………………….
9
Conflict of Interest
……………………………………………………………………………
9
References ……………………………………………………………………………………….
9
F
igures
…………………………………………………………………………………………….
13
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Preface
We all think that scientific research is seeking truth. Nevertheless, based on
my limited experience and research work, I can say that we are far away from
truth, and in this context, it is safer to say that there is no truth in contemporary
science. Science is only our interpretation about the phenomena we observed,
and these interpretations (or scientific theories) are not truth at all and may be
full of mistakes. This also applies to the interpretation or theory presented in this
book. But we have to present these theories or interpretations, as this is the only
way we can exchange and communicate our ideas.
Medical research and healthcare study are at a crossroads. Without the
modern medical technologies, Hippocrates lived to the age of 90, and Luigi
Cornaro was quite sure that he could live to the age of 100 without any illness or
loss of any of his senses long before he was in his 80s. Hardly any contemporary
medical experts have such confidence about their own health. After I successfully
cured my anorexia nervosa (AN) by adopting Luigi Cornaro’s diet, and have been
following this diet for some time (about two years up to now), I can fully
understand why Luigi Cornaro had such firm confidence. So regardless the
astronomically enormous medial knowledge we have nowadays, which is quite
useful in treating certain diseases, our knowledge on how to maintain our health
has progressed very little from the time of Luigi Cornaro 500 years ago. In some
circumstance, all the current medical theories about health lose their
effectiveness, especially when one had been trapped by a special dreadful illness
of anorexia nervosa. It is a well-accepted theory that our genes determined our
body weight. It is quite true when we compare the body weight of different
species. Genes determine that we have the weight of human being, not that of an
elephant. When we are obese or overweight, it is very hard to lose our weight
because our genes enable our body to conserve energy. However, when a person
is sick, especially when he is trapped by anorexia nervosa (AN), he will find this
“genes determine body weight” a nonsense. A person trapped in AN is able to lose
weight very comfortably to any dangerous low point. As a person experienced
from overweight to anorexia nervosa, and then to the recovery from anorexia
nervosa, I really feel that it is not the theory, but the practice of Luigi Cornaro
saved me. Luigi Cornaro set up a model for me and build up my confidence, so
that I can have a calm and peaceful mind to face all the uncertainties in
combating with anorexia nervosa. Without him as a model, I really didn’t have
anything to follow, and I could have been died because of this dreadful illness.
But Luigi Cornaro’s theory in interpreting his experience and practice is actually
completely out of date and wrong. Based on my personal experience, I can
confirm that his diet is not a universal diet which can be used for anybody. It is a
diet only for persons who has triggered upregulated autophagy, and it could be a
poison to people who can eat normally. Also, what I can write down here in this
book is only a very small portion of my experience on anorexia nervosa. I
experienced a lot of paradoxical situations in combating anorexia nervosa that
cannot be expressed in any words, and we cannot simply advice the anorexia
nervosa patients that “you should eat this” or “you should avoid doing that”. The
situation is much more complicated, and it’s only the patient who builds up his
own confidence and has a peaceful mind, can cope with all the difficulties he
encounter and does not make any mistakes to further hurt his health. What I can
say from my experience is that anorexia nervosa is recoverable, as our body has a
powerful capacity of healing itself.
This self-healing ability is encoded in our gene, so every one of us deserves an
illness-free life to the great longevity. It is reported that most of the non-
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communicable chronic disease may be prevented by lifestyle therapeutic
approaches [1]. This does not mean that medical assistance is not important. Yet,
without the self-healing capacity of our body, no medical assistance can work for
our illness. When we fall ill, medical support is necessary; and in some cases, we
need surgery to fix a broken bone. Yet, our body is the only healing organism that
can bring us back to homeostasis from an illness. No artificial glue could fix a
broken bone, if our bone did not have the self-healing capacity. This self-healing
ability is independent of our awareness. No matter we have the knowledge of it or
not, or if we are willing to have this ability to work or not, it will surely work for
us. Yet, the most eminent part of this self-healing ability, the upregulated
autophagy, does not come naturally. It has to be triggered by certain stimuli. As
laymen on this subject, we don’t know how this self-healing process really works,
what we can say is, our human body has far more unexplored latent potentials
than anyone of us can imagine. Yet, just as it is not necessary to be computer
experts before we can use computer, as long as we have faith in this self-healing
ability of our body, and know how this self-healing mechanism is triggered and
maintained, that’s enough. For the rest, no matter whatever conditions currently
we are in, don’t worry and don’t be panic and upset, just keep a calm and peaceful
mind, fully relax ourselves mentally, eat the right amount of the right food at the
right time frame in the day, so that our body is able to do the job in its best.
Luigi Cornaro was not a medical doctor. However, he observed his own health
and wellbeing in relation to his diet and drew general conclusions from it. The
authors are not medical doctors either and do not want to make medical
recommendations. Instead, this book should be regarded as a thought-provoking
impulse for future research.
YU Ligen
Dec 2018 in Singapore
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1. Introduction
According to the DSM-5 criteria [2], Anorexia nervosa (AN) is featured by: A)
Restriction of energy intake relative to requirements, leading to a significantly
low body weight; B) Intense fear of gaining weight or of becoming fat, or
persistent behavior that interferes with weight gain; and C) Disturbance in the
way in which one’s body weight or shape is experienced, undue influence of body
weight or shape on self-evaluation, or persistent lack of recognition of the
seriousness of the current low body weight. Despite the highly destructive
consequences of AN, the etiology is still unclear [3]. It has hypothesized that
multiple factors including biological, psychological, developmental, and
sociocultural factors contribute to the causes of AN [4]. A serious problem
encountered by clinicians is the egosyntonic nature of AN, wherein individuals
with anorexia nervosa value their disorder, and are reluctant to recover from
anorexia [5, 6]. Some of the medical conditions associated with AN are found in
uncomplicated starvation, and a gradual return to normal healthy diet and weight
is a widely used approach in the treatment of patients with anorexia nervosa [7],
but the denial feature of restrictive AN make the recovery very difficult [5-7]. On
the other hand, the ‘appreciating the benefits’ of AN implies that there are
positive aspects of living with AN [6]. Here we report a special case of an adult
male patient developed anorexia nervosa by starvation induced gut illness, and
recovered from AN simply by curing the gut illness with the Luigi Cornaro diet
[8] of “eat but little”. From this case, we suggest that the acute illness in the
dysfunctional gut mucosa could be the trigger of illness induced anorexia, and the
repeated triggering of illness induced anorexia leads to anorexia nervosa. Illness
induced anorexia itself is not an illness, but rather an active host defensive
strategy in response to acute illness [9]. Illness induced anorexia is the
manifestation of upregulated autophagy triggered in the body to restore health.
However, triggering upregulated autophagy (illness induced anorexia) to create a
more sever starvation state in the body to restore starvation induced acute gut
illness is only a partial solution for the gut illness, and is not sustainable. The
situation can only be fully resolved by adopting the healthy diet of ‘eating but
little’, the Luigi Cornaro diet.
2. Case Description and Treatment
In a letter to the BMJ, We (BW and BX) have reported that natural weight loss
by eating less and fasting can greatly relieve the plantar fasciitis of one of the
authors (LG, hereafter refers as the patient) [10]. As the benefit is so big and
obvious, also in order to prevent the recurrence of plantar fasciitis, and prevent
the remaining body fat from causing other illness, our patient had continued the
fasting and eating less process, even though a normal BMI (BMI = 23) had
already been reached. His stomach is quite weak at this stage, as he occasionally
have sever dizziness after a normal meal, and followed with black stool in the
next 2 to 3 days, indicating that there is acute illness like bleeding in the upper
part of the GI tract, especially in the stomach. Therefore, he was in extreme fear
of eating normally, and only when he ate very less or without any food in his
stomach in a day, he felt relieved and quite energetic. His mind felt so clear, calm
and peaceful, and the whole body was in a harmonic state filled with happiness
when he was in a fasting state. His body weight lost quite rapidly, with an average
daily weight loss of 200 – 300 grams. Within two months, his BMI dropped from
23 to 20, and he had a body mass less than 50 kg. While our patient was very
satisfied with his weight loss success, thought that he had reached a special
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biological state, the hibernation of human being, we were extremely worried, as
this medical condition resembles anorexia nervosa, which is quite common for
some of our classmates. We urged him to have a health check. The health check
results showed that he had moderate anemia, as shown in Table 1 for
haematology (data column for Oct 2017), which indicates that he had really
developed anorexia nervosa. At this stage, our patient realized that his weight
loss progressed too far, and he decided to stop the weight loss to avoid any
damage to his health, as he knows that a healthy body and mind and a joyful life
are far more important. Since then, he has been following the Luigi Cornaro diet,
resumed to eat three or four meals a day, but as less as possible (around 100-200
grams cooked food) in each meal, and only eats foods that are very easily to be
digested to help the restoring of his weak stomach. The health check after half a
year of this incident shows that his anemia is greatly alleviated, as the data shown
in Table 1 Column for June 2018, and all other symptoms of anorexia nervosa is
resolved after the recovery of his gut function. Our patient is now able to
maintain a relative healthy body weight of around 50 to 52 kg by continuing the
“eat but little” diet. We are relieved. After adopting the Luigi Cornaro diet for
almost two years from then up to now, our patient finds that he is extremely
healthier than ever. The good virtues reported by Luigi Cornaro is also gradually
shown on our patient now.
Table 1. Haematology Results for Patient in Oct 2017 and June 2018
HAEMATOLOGY RESULT UNIT REF. RANGE
Oct 2017 June 2018
Haemoglobin * 9.7 13.3 g/dL (13.5 - 18.0)
Red cell count * 3.1 4.31 x1012/L (4.5 - 6.5)
Total White cell
count * 3.3 4.6 x109/L (4.0- 11 .0)
Differential Count: % Abs
% Abs
Neutrophils 67.5% 2.23 70.2 3.23 x109/L (2.00- 7.50)
Lymphocytes *
21.1%
0.70 20.9 0.96 x109/L (1 .50 - 4.00)
Monocytes 6.9% 0.23 6.7 0.31 x109/L (0.20 - 0.80)
Eosinophils 3.3% 0.11 1.2 0.06 x109/L (0.04 - 0.40)
Basophils 1.2%
0. 1.0 0.05 x109/L (< 0.21)
Haematocrit (PCV) * 0.29 0.39 (0.40- 0.54)
MCV 93 91 fL (78- 98)
MCH 31 31 pg (27- 32)
MCHC 34 34 g/dL (31 - 36)
RDW 14.1 21 % (11.0 - 15.5)
Platelets 185 154 x109/L (140- 440)
Peripheral Blood
Film
There is a
moderate
anaemia.
Normal
peripheral blood
film. No early
Cells seen.
In the following chapters, we will try our best to interpret these special
phenomena on our patient before and after he adopted the Luigi Cornaro diet.
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3. Terminologies used in this Book
3.1 Autophagy
Autophagy is the degradation of intracellular components in lysosomes to
remove altered or dysfunctional proteins and organelles [11, 12]. In normal
physiological conditions, a low level of basal or constitutive autophagy occurs to
maintain cellular homeostasis by controlling the turnover of damaged proteins
and organelles [13]. When autophagy is upregulated, it functions as an adaptive
cellular mechanism to deal with stress stimuli such as starvation, oxidation, and
pathogen invasion [11, 12].
3.2 Illness Induced Anorexia and Upregulated Autophagy
Decreased food consumption (anorexia) is the most common sign of infection
and sever injury [14]. It is an active host defense strategy for pathogen
elimination and enhancing healing of injury [9, 15, 16]. Unlike the starvation
invokes regulatory mechanisms aimed at conservation of protein mass in healthy
subjects, patients with illness induced anorexia have increased energy
expenditure and protein catabolism, associated with profound neuroendocrine
alterations [16]. In pathological conditions (like infection, injury or cancer),
upregulated autophagy will be triggered to eliminate pathogens and recycle
damaged macromolecules and organelles to reinstall health [17, 18]. As starvation
is a strong stimulus for autophagy [19], it is natural to suspect that illness
induced anorexia is the manifestation of upregulated autophagy. By losing
appetite (anorexia), our body imposes an extremely sever starvation state and
trigger the upregulated autophagy to deal with a wide range of cellular stresses
including cell starvation, hypoxia, nutrient and growth-factor deprivation,
oxidant injury, genotoxic agents, and other damaging insults. At the initial stage,
upregulated autophagy has to be triggered by sever pathological conditions like
infection, injury, or cancer, and accompanied with anorexia (loss of appetite).
After repeated triggering, the human body may remember this upregulated
autophagy state, and upregulated autophagy can be triggered by simple
starvation like eat less or fasting.
3.3 Gut mucosa atrophy and dysfunction
The gut mucosa is a strong barrier between our main body and the contents of
our stomach [20, 21]. It also stops any nutrition in our main body from being
transported to itself (the gut mucosa). Nutrition for our stomach mucosa solely
relies on the food we eat. Short duration (< 18 hours) fasting is good for resting
gut mucosa and recovering it from any minor injury during food digestion. Yet,
long duration (>24 hours) fasting will result in gut mucosa atrophy and
dysfunction [22, 23], which makes our main body prone to bacteria translocation
from gut and leads to sepsis [23].
3.4 Anorexia nervosa (AN)
When illness induced anorexia is triggered by starvation induced gut illness
(like bleeding in a dysfunctional gut after improper food intake), the situation will
be quite complicated. Imposing a much severe starvation state (anorexia) and
triggering upregulated autophagy can resolve the gut bleeding effectively, but is
not sustainable, as the nutrition from upregulated autophagy cannot reach gut
mucosa, and dysfunction in gut persists. The repeated cycles of gut illness →
triggering illness induced anorexia → illness cure → non-regular or excessive
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eating → gut illness makes illness induced anorexia to be chronic and leads to
anorexia nervosa.
After repeated triggering of illness induced anorexia, the body remembers the
upregulated autophagy state, and can easily resume this state even without
anorexia, i.e. loss of appetite. So patients with anorexia nervosa normally have
powerful regulation of appetite.
3.5 Food Phobia
Food phobia is the extreme fear of food intake as a result of: (1) the
uncomfortable feeling when upregulated autophagy is stopped, and (2) the injury
to the atrophied GIT mucosa by improper food intake. Food phobia might be the
main cause of DSM-5 diagnostic criteria Feature A of anorexia nervosa:
“Restriction of energy intake relative to requirements, leading to a significantly
low body weight” [2].
3.6 Atypical Anorexia Nervosa (AAN)
Atypical anorexia nervosa (AAN) is state of anorexia nervosa (AN) with
normal healthy body weight. Like AN, AAN is no longer anorexia (loss of
appetite). Yet, the upregulated autophagy state can be easily triggered and
maintained in AN and AAN patients by simple starvation like eat less or fasting.
4. Gut protection as the most important issue for health
We all think that our stomach is inside of our body. Yet, the most important
part of our stomach, the gut mucosa, is actually separating itself and the content
of our stomach (the eaten food) from our main body [20, 21]. The gut mucosa
forms a strong barrier between itself and our main body. Because of this barrier,
the nutrition for our stomach mucosa cannot be transported from our main body,
and is solely relaying on the food we eat. As stated earlier, fasting longer than 24
hours will result in stomach mucosa atrophy, which may lead to gut mucosa
dysfunction, bacteria translocation and sepsis. So fasting longer than 24 hours is
bad to our gut health. To maintain the homeostasis of the gut mucosa, frequent
food intake during the day is necessary.
5. Autophagy as the main component of our body’s self-healing
capacity
As stated in Introduction, our body has a strong self-healing ability, and
autophagy is a main component of this self-healing capacity. It is a highly
regulated process in eukaryotes to maintain homeostasis and manage stress
responses. It has multiple physiological functions including cellular quality
control, energetic balance maintenance, and pathogen cleaning [24]. Serum
starvation is a strong stimulus of autophagy. So, in order to trigger the self-
healing process, we need to keep serum starvation from time to time.
Here is a paradox on food and nutrition: we need the serum starvation to
perform the self-healing, we also need nutrition from food to maintain an ideal
body mass for the proper performance of this self-healing process. In the
meantime, minimum regular intake of food is essential for the maintenance of
the homeostasis of our gut mucosa and the overall health of our body, as a strong
gut ensures the proper food digestion and the subsequent absorption by small
intestine, as well as prevents bacteria translocation and sepsis.
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6. Illness Induced Anorexia as Manifestation of Upregulated
Autophagy Plays an Important Role in Self-Healing
Many studies show that infection-induced anorexia (IIA) as an active host
defense strategy promotes health recovery during an infection [9, 25, 26]. Also,
many research show that autophagy is a highly regulated process in eukaryotes to
maintain homeostasis and manage stress responses, and it can be stimulated by
multiple forms of cellular stress, like starvation and intracellular pathogens. Here
we propose that, autophagy is the central component of the self-healing system of
our body. We suspect that the most eminent part of this self-healing process
happens when the autophagy is upregulated, and illness induced anorexia is a
manifestation of this upregulated autophagy in response to various sever stress or
acute illness, as shown in Figure 1 [27] (on page 13).
It is reported in [17] that upregulated autophagy is critical during the early
neonatal period and can be found in various tissues, including the liver, heart,
lung, diaphragm, pancreas, and the gastrocnemius muscle after birth, due to the
sudden interruption of trans-placental nutrient supply, when neonates face life
threatening severe starvation. It seems that upregulated autophagy (illness
induced anorexia) is not coming naturally. It has to be triggered by some acute
illness, or extreme stress. And it is enhanced by repeated triggering, so that our
body is able to remain in this upregulated autophagy state after the elimination of
the triggering illness or severe stress.
Here is another paradox on health maintenance. We all thought that good
health is a state of complete physical, mental and social well-being without any
disorder in one’s body. Yet, such state never exists in reality. As living creature,
we face all kinds of stresses, which are changing from time to time, from day to
day. So mild physical, mental and social disorder is our norm, and good health
implies that our body is applying its powerful self-healing ability to heal from
these mild disorders from time to time. Moreover, to trigger the self-healing
ability and remain in this state, we need some manageable but acute illness, and
the repetitions of this illness. Health is the activation of the healing power from
time to time to cope with the various physiological stresses we encounter in our
daily life to maintain the dynamic homeostasis of our body. When the most
eminent part of the self-healing ability of our bodies, the upregulated autophagy
state, is running in our body from time to time, these mild disorders will be
eliminated, preventing them from being developed to sever illness that beyond
the ability of our self-healing capacity.
7. Anorexia Nervosa as an Abuse of Upregulated Autophagy
Illness induced anorexia is beneficial to the host only when 1) the acute illness
is not of genetic origin, and can be rectified by upregulated autophagy in short
time; 2) the host maintains a healthy body weight, so that the health of host is not
sacrificed. For common individuals who eat normally, he may encounter acute
illness that triggered upregulated autophagy (illness induced anorexia)
occasionally, but as there is no repeated triggering, upregulated autophagy
(illness induced anorexia) is transient, and is hardly being noticed. Only for those
who have anorexia nervosa, our body can easily maintain in the upregulated
autophagy state by serum starvation. The problem now for us is, because of the
repeated triggering of upregulated autophagy by certain acute illness or extreme
stress, the acute illness or extreme stress becomes part of us chronically, which
put our health in danger. For our own health, we need to take a step back: recover
our health and get rid of that illness. Specifically, because of the long time fasting
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or gut starvation, we have developed mucosa atrophy and dysfunction in our gut.
Now we need to cure this dysfunction in our gut.
Anorexia nervosa (AN) is a serious health problem. Here we suggest that
illness induced anorexia triggered repeatedly by starvation induced gut illness
(like gut bleeding) is the main cause of anorexia nervosa, and food phobia is the
main feature of AN.
There are two factors contributing food phobia. When one is overeating so
that upregulated autophagy is stopped in the main body. The loss of protection
from upregulated autophagy creates a quiet uncomfortable feeling in the body,
contributing to the food phobia. The second factor is the injury like gut bleeding
to the dysfunctional gut by overeating which also contributes to the food phobia.
Food Phobia was first described by Luigi Cornaro in his Discourses on the
Sober Life [8]: “On the contrary, I conclude, especially from the late trial I have
had, that excesses in eating and drinking are often fatal. Four years ago, I
consented to increase the quantity of my food by two ounces, …. This increase,
had, in eight days’ time, such an effect upon me, that, from being cheerful and
brisk, I began to be peevish and melancholy, so that nothing could please me. On
the twelfth day, I was attacked with a violent pain in my side, which lasted
twenty-two hours and was followed by a fever, which continued thirty-five days
without any respite, in so much that all looked upon me as a dead man.”
The above description on food phobia also indicated that, Luigi Cornaro is the
first recorded anorexia nervosa case in history, much earlier than Sir William
Gull [28] who termed the condition as anorexia nervosa and described the
symptoms of the condition. In addition, Luigi Cornaro’s food phobia was not
cured throughout his lifetime.
When a patient with dysfunctional gut mucosa doesn’t know how much he
should eat, he will often choose not to eat, or eat very less, leading to the
excessive use of upregulated autophagy, and results in Anorexia Nervosa.
AN is the aftermath of gut illness induced anorexia, it is no longer anorexia
(loss of appetite).
8. Introduction to the Luigi Cornaro Diet [8]
“Let thy food be medicine and thy medicine be food.”
– Hippocrates, (460 BC – 370 BC)
Luigi Cornaro was a Venetian nobleman in the 15th century. When he was
around 35 to 40 years’ age, he had a near-death experience, which he ascribed to
the intemperance living of too freely eating and drinking. Under the advice of
some doctors, he adopted a strictly restrictive diet using food only to cure his
complaints. For some time he restricted himself to a daily allowance of 12 ounces
of solid food and 14 ounces of wine. According Luigi Cornaro, the 12 ounces of
solid foods were bread, panado, eggs (the yolk), and soups; and the 14 ounces of
wine was new wine. There were two general rules set by Luigi Cornaro: quality
and quantity. Quality means avoiding food or drinks, which are found to disagree
with the stomach. Quantity is to avoid taking more than the stomach can easily
digest. As long as one follows these two rules of eating and drinking, he can be
regarded following Luigi Cornaro’s Diet. When one eats quite less like Luigi
Cornaro, any food will be nutritious. So in principal, one can eat and drink
anything that can be easily digested by one’s stomach. Yet, the incorporate of salt
in diet will be a big issue when one eat very less. Insufficient salt intake will result
in electrolyte imbalance in our body in long term [29, 30]. In case of Luigi
Cornaro, the soup provide a course for adding salt.
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While one can eat any easily digestible food in the Luigi Cornaro diet, the 14
ounces of new wine is an essential component of the this diet. New wine belongs
to raw fermented food, and it contains lots of probiotics and enzymes that are
very good for gut mucosa homeostasis [31, 32]. Research show that probiotics are
good for mucosa to recover from atrophy [23]. As a family tradition, our patient
has been consuming fermented rice for more than 40 years since his childhood,
and his experience shows that fermented rice helps the gut to recover from
uneasiness more quickly.
The Luigi Cornaro diet is a diet specially for people developed anorexia
nervosa, or atypical anorexia nervosa, and it is not a diet for ordinary persons.
This diet has nothing to do with calorie restriction or fasting. The Luigi Cornaro
diet sets triggering and maintenance of upregulated autophagy in body as a
prerequisite, while the diet itself is not a stimulus strong enough to trigger
upregulated autophagy. On this point, Friedrich Nietzsche [33] is correct by
saying that Luigi Cornaro “mistaking the consequence for the cause”. In his book
[33], Nietzsche said: “The worthy Italian saw in his diet the cause of his long life:
while the prerequisite of long life, an extraordinarily slow metabolism, a small
consumption, was the cause of his meagre diet. He was not free to eat much or
little as he chose, his frugality was not an act of ‘free will’: he became ill when he
ate more.” However, we need to point out that the mechanism behind the Luigi
Cornaro diet is the upregulated autophagy, not the extraordinary slow
metabolism. By recycling and reusing the dysfunctional body components,
upregulated autophagy enables a person to be sustainably relaying on a very
small consumption. On the contrary, the metabolism in AN patient is actually
quite high [16]. In addition, the food phobia as the result of dysfunctional gut
mucosa forced Luigi Cornaro to only eat 12 ounces of cooked food, and 14 ounces
of new wine, no more no less.
For a diet that will be adopted for life long, it should be as simple as possible.
So we have simplified the Luigi Cornaro diet to only two courses – one is the
steamed eggs as solid food, the other is the fermented rice as drink to fit for the
need of our patient. We choose eggs and fermented rice because eggs contain
plenty of protein, and fermented rice contains a lot of glucose which are essential
for restoring of the glycoprotein, which is the major constituents of gut mucosa
[20, 21, 34].
8.1 The Modified Luigi Cornaro Diet
Steamed eggs: 3 eggs mixed with water and salt to form 400 ml soup,
steamed for 20 minutes, as shown in Figure 2 (on page 13).
Preparing fermented rice as shown in Figure 3 (on page 13): Cook the
rice with millet (4:1 or 5:1) with less water. The cooked rice should be a bit dry for
air to going in between the rice grains during the fermentation process. After the
rice is cooled down, mix the cooked rice with yeast powder thoroughly, put it in a
pot and make a hole in the center of the mixture for collecting the rice wine.
Loosely cover the pot. Given the climate like that in Singapore, wait for 1 to 2
days, and the rice wine will be ready for consume in raw (No need to cook the rice
wine, as we need to use the living probiotics in the rice wine to help us to digest
other food).
In the first few weeks of our patient’s refeeding, when the gut was very weak,
only the liquid wine and steamed eggs was consumed, with an amount less than
50 ml in each meal. When the gut mucosa condition was improved, his food was
gradually increased to 100 ml of rice wine and steamed eggs, and he started to
consume the solid part of the fermented rice wine. His food consumption does
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not exceed 200 ml or grams even if the function of the gut mucosa is fully
recovered to maintain the upregulated autophagy in the main body.
When the gut is fully recovered and functioning, the following amount of food
may be consumed daily:
Morning 100-200 g of fermented rice. Small amount of any food that I have at
home.
Noon and Afternoon: Steamed eggs: the 400 ml steamed eggs can be served as
two meals, lunch and afternoon (around 4-5 pm).
Fruits (mandarin, melons, banana etc.) 200-500 g daily when the gut mucosa
is fully functioning. If the gut is weak, consume only small amount of fruits, and
use the teeth to squeeze out the juice of the fruit, only consume the juice, and spit
out the solid part of the fruits.
Nuts (walnut, almonds, dates, etc.), up to 150 g daily. No nuts should be
consumed when the gut is weak.
Stop eating any food 5 hours before going to bed.
8.2 Exercise
Moderate exercises, 10000 step a day walking is maximum, especially for
elder people. Madam Juliana Young Koo [35] who lived to the age of 111 stated
that her secrete of longevity is "No exercise" [36]. Most of us believe in that
exercises are good for our health. However this belief is based on the fact that our
body can recover from exercise induced injury, and we become stronger after this
self-healing process. Yet we must understand that our body’s self-healing ability
has its limit, and don’t do anything exceed that limit.
8.3 Monitor body weight everyday
In the upregulated autophagy state, our body is eliminating pathogens and
recycling damaged macromolecules and organelles in the cells to maintain the
homeostasis of our body and restore our health. The main target of our body has
been shifted from energy conservation to fighting diseases and recovering health
[15], so weight loss can be quite aggressive. We all have the experience of losing 1-
2 kg within one to two days when we have infection and illness induced anorexia
is triggered. And it is easily for a cancer patient to lose 10 kg in one or two
months. It was reported in 2008 [37] that Prof Pope Rosemary of Bournemouth
University, who had suffered from anorexia nervosa since her teens, lost 10 kg
within 8 month, which led to her tragic untimely death. It is not noticeable if one
drop of 30 grams of body mass in one day, and this 30 grams’ weight loss can be
accumulated to over 10 kg over one year, which is quite significant. By taking
body weight every day, we can ensure that our body mass is not drop drastically
and unnoticed over a certain period of time.
Postface
As mentioned in Section 8 that the Luigi Cornaro diet is only fit for people
who have already triggered and maintained upregulated autophagy in the body
without anorexia, i.e. for people has already developed anorexia nervosa or
atypical anorexia nervosa, and is not for ordinary people. Luigi Cornaro had
repeatedly mentioned in his discloses [8] that it was extremely hard for ordinary
people to follow his diet, although he didn’t know the reason. For example he
said: “Now, I am often at a loss to understand why men of fine parts and
understanding, who have attained middle age, do not, when they find themselves
attacked by disorders and sickness, betake themselves to a regular life, and that
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constantly.”; “One of the younger of them said that I appeared to enjoy the special
grace of being able to relinquish, with ease, one kind of life, and embrace another,
a thing which he knew from theory to be feasible, but in practice to be difficult,
for it had proved as hard to him, as easy to me.”; “There are some sensualists, my
Lord, who say that I have thrown away my time and trouble, in writing a treatise
upon temperance, and other discourses on the same subject; alleging, that it is
impossible to conform to it,”
For ordinary people who cannot eat less in each meal, they may eat three
meals a day normally, but stop eating 5 hours before going to bed, so that one’s
stomach is empty during the whole bed time, to trigger the starvation induced
passive autophagy in the body every day. By doing this, they will also be protected
by the passive autophagy, and enjoy good health throughout their life.
Acknowledgments
The contents of this booklet were first published on the 20th Global Obesity
Meeting during August 24-25 2018 in Singapore as oral presentation. The
authors are greatly indebted and sincerely thankful to Dr Hubertus Himmerich of
King’s College London for his valuable suggestion and encouragement of putting
the idea into a book, and his critical review comments on the contents of this
booklet.
Conflict of Interests
On behalf of all authors, the corresponding author states that there is no
conflict of interest.
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Figure 1. Triggers of upregulated autophagy (anorexia)
(a) 3 eggs (b) mixed well with water and salts (c) steamed egg soup
Figure 2 Preparation of steamed egg soup
(a) Rice yeast (b) Cooked rice mixed with yeast (c) Fermented rice with wine
Figure 3. Preparation of rice wine
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Upregulated autophagy is the key to our health:
Institute of Materials (East Asia)
www.materials.org.sg
S$17.99 Singapore / US$12.99
ISBN 13: 978-981-14-0181-7
Anorexia nervosa is a serious physical problem, the illness/injury
induced anorexia plays a decisive role in developing anorexia nervosa;
Illness/injury induced anorexia is a manifestation of upregulated
autophagy;
Upregulated autophagy is the most eminent component of our body’s
self-healing capacity; The starvation state of illness/injury induced
anorexia is essential for the triggering and maintenance of upregulated
autophagy.
The nutrition produced by upregulated autophagy cannot reach gut
mucosa, due to the strong barrier nature of the gut mucosa. So eating is
essential for the homeostasis of gut mucosa;
Luigi Cornaro diet is a unique diet in restoring the GIT mucosal
homeostasis and integrity, and remaining a serum starvation in the
body, so that upregulated autophagy is running most of the time to keep
the body of patient in good health.
With the help of upregulated autophagy, every of us deserve an illness
free life to the great longevity.
