Xavi Cañellas advocates for a clinical approach that places each person's life story at the center and challenges a medicine too accustomed to interpreting the body through diagnoses, biomarkers, and isolated treatments.
The question guiding the practice of Xavi Cañellas is not merely which diagnosis appears in a blood test or what name a set of symptoms receives, but rather what has happened to a person for their organism to have reached that point.
A specialist in clinical Psychoneuroimmunology and molecular biology, Cañellas maintains that the organism cannot be understood as independent parts and that each patient's history is part of their biology.
“My philosophy is to care for people, not diagnoses, not numbers, not biomarkers,” he explains during his conversation with Wellness Forum. In his practice, this position translates into reconstructing the patient's biography to try to identify the mechanisms that may lie behind their state of health.
Diagnostic tests and biological markers still play a relevant role, but they need a clinical hypothesis to give them meaning. Data loses its explanatory power when it replaces the story, and a single blood test ends up being interpreted as if it could describe the person on its own.
The same diagnosis does not necessarily mean the same problem
Cañellas turns to SIBO to explain the difference between identifying an alteration and understanding why it has occurred. Two people can receive the same diagnosis and have arrived at it through completely different paths.
Small intestinal bacterial overgrowth can be related to alterations in digestive function, changes in the microbiota, issues linked to gastric acid or bile production, overgrowth of other microorganisms, or circumstances affecting the digestive system's functioning. From his perspective, merely eliminating the overgrowth without investigating what favored it leaves the central question unanswered: why did it appear in that particular patient. This distinction forces a separation between two concepts often used as if they were equivalent: disease and dysfunction.
For Cañellas, a disease corresponds to a clinical entity with identifiable biological mechanisms, while a dysfunction describes an alteration in functioning that can have multiple causes. SIBO, within this framework, would be a dysfunction rather than a disease in itself.
The difference changes how the problem is approached. If treatment focuses exclusively on the observable phenomenon—in this case, the excess of bacteria—improvement may occur without the conditions that favored its appearance disappearing. Relapse would then be a possible consequence of having treated the result without intervening at the source.
Cañellas extends this reasoning to many of the tools currently circulating in the health and wellness sphere. An intervention may have scientific evidence and prove useful in certain circumstances, but that does not make it an appropriate response for everyone.
“We need the right tool for the right problem,” he summarizes. This statement takes on particular relevance at a time when health communication also functions as a marketplace of solutions. Red light, fasting, supplements, diets, probiotics, training, cold, heat, or various metabolic optimization strategies can all have their place. The difficulty arises when a tool is presented as a universal answer.
From biomarker to biography
Contemporary medicine possesses an extraordinary capacity to measure. Blood tests, imaging, sequencing, biomarkers, and devices capable of continuously recording various physiological variables have notably expanded the observation of the organism.
That capacity does not by itself guarantee deeper understanding. For Cañellas, a blood test is a photograph: it reports on certain parameters at a specific moment, but it needs a clinical history to interpret that data. “A complementary test without a real patient history makes no sense,” he asserts.
Listening thus occupies a central place in his clinical approach: the patient arrives at the consultation with a considerable amount of information, though often disorganized: symptoms, family events, work changes, losses, stress, eating habits, sleep, personal relationships, medical history, and experiences that may date back years. The professional's role is to organize that material and turn it into hypotheses that can then be tested through relevant diagnostic tools.
The story does not replace science; it provides context, and that contextualization is especially relevant in complex processes where different body systems interact and there is not always a linear relationship between cause and effect.
The gut does not end where digestion finishes
A substantial part of Cañellas's work has developed around the microbiota and the relationship between the digestive system and other systems. In the interview, he insists on the neurological component of the gut and recalls that the enteric nervous system contains an extraordinary number of neurons, in addition to maintaining a close relationship with the central nervous system.
The microbiota should also not be understood as an isolated compartment. Contemporary scientific literature has consolidated interest in the interactions between microbiota, nervous system, immunity, and metabolism, although the magnitude and clinical relevance of many of these relationships continue to be the subject of research.
The practical conclusion Cañellas draws is that intervening on the gut without considering the physiological and life context in which it functions can offer an incomplete explanation. His years of public education work have consistently emphasized the connection between microbiota, stress, nervous system, and behavior.
Stress as part of the clinical history
Another recurring dimension in his discourse relates to how certain life events can modify physiology.
A person going through grief, enduring a demanding family situation for years, or living under constant work pressure is not simply having a rough patch. They may change their eating habits, sleep worse, alter their physical activity, shift their relationship with food, and maintain a heightened activation of the stress system over long periods.
That does not mean a specific emotional experience is by itself the cause of an illness. The relationship between stress, behavior, nervous system, immunity, and disease is more complex and does not allow for automatic explanations.
For that reason, Cañellas speaks in terms of hypotheses: rather than assuming that one event directly explains a pathology, he proposes building a clinical hypothesis and then trying to dismantle it. If the available data does not contradict it, it can become a plausible explanation that helps guide the intervention.
That way of reasoning restores prominence to the clinical process and avoids the temptation to find a single cause for problems that are, in many cases, multifactorial.
The paradox of an increasingly informed society
The wellness world lives with an evident contradiction. Health information has multiplied, but so have contradictory messages.
Every week a new recommendation appears on nutrition, supplements, fasting, exercise, sleep, or longevity. The accumulation can generate the feeling that there is always something more to do and that any everyday decision should respond to an optimization strategy.
Cañellas believes that health communication has helped raise awareness, although it can also produce a kind of “illness from excess health”: a permanent search for improvement that ends up turning self-care into another source of pressure.
If wellness is reduced to accumulating protocols, it reproduces the very problem it aims to correct. The person stops being the center and becomes a set of parameters that must be kept under control.
His proposal sits elsewhere: understanding why a person eats the way they eat, how they sleep, what place stress occupies in their life, what events have marked their trajectory, what can really change, and what intervention makes sense for them.
The patient is also part of the treatment
This approach also changes the relationship between professional and patient. If the goal is for a person to understand what is happening, they stop being a passive receiver of instructions.
Cañellas questions the idea that the healthcare professional is the one who “cures” the patient. The doctor, therapist, or health professional can act on certain mechanisms, provide tools, and accompany processes, but the organism and the person themselves actively participate in recovery.
This statement does not mean denying the role of medicine, but rather recognizing the patient's responsibility within the process. In chronic, autoimmune, or established organic damage conditions, achieving remission or remaining asymptomatic does not necessarily equate to eliminating the disease or its predisposition.
Cañellas himself acknowledges that boundary when asking what “being cured” really means in an autoimmune disease. A genetic predisposition does not disappear because symptoms disappear, and irreversible organic damage cannot simply be repaired through lifestyle changes.
Distinguishing between remission, disease control, absence of symptoms, and cure is essential to prevent integrative medicine from ending up making promises as simplistic as those it criticizes.
Medicine's great deficit may be time
One of the most relevant points of the conversation has to do with a less sophisticated issue than microbiota or personalized medicine: the time available to listen.
Cañellas points out that a healthcare system in which a consultation can be reduced to a few minutes makes it difficult to take an approach based on the patient's history. The problem, he insists, does not necessarily lie with the professional in front of the patient, but with a system organized around a particular management of time and resources.
Patients have also learned to go to consultations seeking an immediate answer: a diagnosis, a prescription, or a test. The lack of time to understand the problem increases the pressure to find a quick solution, even when that solution does not always match the complexity of the case.
Technology will make it possible to measure more and more variables, detect previously invisible patterns, and personalize certain interventions. None of those capabilities eliminates the need to interpret information or replaces the clinical relationship.
More prevention, fewer universal prescriptions
Cañellas takes this reflection into the realm of prevention. In his view, a deep healthcare transformation would require shifting part of the focus from treating disease toward building health before it appears.
Eso implica educación alimentaria, hábitos saludables, actividad física, sueño, gestión del estrés y alfabetización sanitaria, pero también una transformación cultural. La prevención no puede consistir únicamente en pedir al individuo que se cuide más mientras el entorno continúa promoviendo comportamientos que dificultan ese cuidado.
En la conversación pone como ejemplo el alcohol y la alimentación, y cuestiona la influencia de los intereses económicos sobre determinados mensajes de salud pública. Más allá de la valoración concreta de cada industria o campaña, la cuestión que plantea resulta pertinente: qué capacidad tiene realmente una persona para tomar decisiones saludables cuando recibe información contradictoria y vive en un entorno que a menudo juega en sentido contrario. La respuesta no puede reducirse a otro listado de consejos. Una recomendación aislada tampoco puede explicar la salud de una persona.
La medicina personalizada empieza mucho antes del tratamiento
La propuesta de Cañellas no consiste tanto en añadir nuevas herramientas al arsenal sanitario como en modificar el orden en que se utilizan. Primero está la persona, después su historia y, a partir de ahí, las hipótesis que deben contrastarse con las pruebas y las herramientas disponibles.
La secuencia parece sencilla, pero choca con una cultura sanitaria fascinada por los datos, la tecnología y las soluciones rápidas. También obliga a aceptar que dos personas con el mismo diagnóstico pueden necesitar estrategias diferentes, que una intervención eficaz para un paciente puede resultar irrelevante para otro y que modificar un biomarcador no siempre equivale a resolver aquello que provocó su alteración.
La salud personalizada no debería confundirse con una analítica cada vez más sofisticada ni con un protocolo diseñado a partir de un número creciente de variables. Personalizar significa comprender a quién se está tratando. Esa comprensión requiere contexto, algo que ninguna máquina puede proporcionar por sí sola.
En un momento en que el wellness corre el riesgo de convertirse en una sucesión infinita de protocolos, suplementos y estrategias de optimización, la reflexión de Cañellas devuelve la conversación a la relación entre la persona y su propia salud.
No se trata de elegir entre medicina y estilo de vida, entre tecnología y escucha, entre fármacos y hábitos. Se trata de entender qué papel corresponde a cada herramienta y qué problema se intenta resolver antes de decidir cómo abordarlo.
Una medicina más personalizada no dependerá únicamente de medir más, sino de interpretar mejor la información disponible y de recuperar una práctica clínica en la que escuchar vuelva a formar parte del diagnóstico.
