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PENGUIN BOOKS

The Pioppi Diet

‘This book is revolutionary. It should be read by everyone’

Sir Richard Thompson, Her Majesty The Queen’s personal physician 1984–2005 and Past President of the Royal College Of Physicians

‘A fearless and brilliant book that stands to dramatically improve the nation’s health’

Professor David Haslam, Chair, National Obesity Forum

‘Changing lifestyles is essential to tackle the ailments of obesity and this book is an articulate, common sense and practical way of choosing wisely what you eat. It is a must have for every household and a must read for every medical student and doctor’

Professor Dame Sue Bailey, Chair, Academy of Medical Royal Colleges

‘When delivering education for the prevention and management of obesity and type-2 diabetes, I see immense benefits when people adopt a real-food dietary approach eliminating refined carbs and incorporating natural healthy fats. This book is a must for anyone who wishes to improve their health’

Dr Trudi Deakin PhD, Chief Executive and Research Dietician for X-Pert Health and founding member of the Public Health Collaboration

‘This brilliant book by Aseem Malhotra reinforces the message that the obesity epidemic is eminently reversible and provides clear, definitive, unambiguous information about the key role of nutrition and lifestyle on the causation and reversal of the chronic diseases plaguing the western world. The public, healthcare and policy makers must take heed’

Professor Zbys Fedorowicz

‘It is ridiculous that we treat diseases with a multitude of drugs that potentially can make patients even more ill without addressing the root cause. This superb ground-breaking book reveals that THE best MEDICINE is actually a HEALTHY LIFESTYLE AND HEALTHY NUTRITION’

Esther van Zuuren, MD, Methods Editor DynaMed

‘Cardiologist Dr Aseem Malhotra’s lifestyle plan has the potential to reverse India’s heart disease and type-2 diabetes epidemics. This book is a must read’

Kapil Dev, former Indian Cricket Captain

‘I am more convinced every day that the nutrition principles contained in The Pioppi Diet are the key to improving our health and reversing the devastating effects of chronic diseases such as type-2 diabetes and cardiovascular disease’

Professor Peter Brukner, Sports and Exercise Physician, Australian cricket team doctor

‘Thankfully, over the last decade there has been an enormous backlash against the now defunct low-fat message. Dr Aseem Malhotra has been at the forefront of the push to move low-fat eating into the history book of medical mistakes. If society adopted the principles in Dr Malhotra’s new book The Pioppi Diet, many cardiologists would be twiddling their thumbs due to lack of work’

Dr Ross Walker, Preventative Cardiologist, Sydney, Australia

‘Aseem Malhotra’s easily accessible book conveys a message which is of paramount importance for individual and public health: the way we live is a root cause of almost all non-communicable diseases we are faced with today. Using drugs as a primary means to restore the damage done is as ridiculous as trying to empty the ocean with a thimble’

Hanno Pijl, internist-endocrinologist, professor of Diabetology, Leiden University Medical Center, The Netherlands

‘Modern society has lost its way in combining the best science and practice of nutrition and turning it into good health. At last here is your guide to getting back on track and helping us all live longer, better lives’

Grant Schofield PhD, Professor of Public Health Auckland University of Technology, Chief Advisor Health and Nutrition, New Zealand Ministry of Education

‘An essential read that profiles the most powerful drug in the world: Lifestyle; spelled out in all its simplicities. Eat whole, unprocessed foods, increase movement, reduce stress and don’t smoke to live a long, healthy life’

Caryn Zinn PhD, NZ Registered Dietitian and AUT Senior Lecturer

Foreword by Professor David Haslam, Chair, National Obesity Forum

Being a renowned and popular interventional cardiologist is impressive, to be able to energetically communicate knowledge and skills over a wide range of written and broadcast media is even more notable, but to fearlessly broadcast controversial science which is not widely accepted by the public or the medical profession, despite being aware of the furore it will cause, is exemplary. This book is fearless, and takes religious dietetic dogma by the neck with both hands and gives it a severe shaking. It reveals why current backward thinking and dangerous teaching came about due to flawed research seventy years ago, and how the medical profession should hold up its hand, accept the blame for the current obesity epidemic, and make up for it by apologizing and shouting the correct message from the hilltops. There is nothing fanciful about the message or the science upon which this book is based. It relies on genuine and impeccable sources, and can be trusted implicitly.

There is increasing concern around the growing importance of not being overweight, obesity and type-2 diabetes globally. Einstein described the insanity of attempting the same failed solutions over and over again, hoping that they’ll work next time; this encapsulates the direction in which academia and government are heading towards obesity management. Failed science needs to be questioned, not reinforced. The recent government Eatwell Guide is a case in point – a high-carbohydrate diet, which has played a major part in the obesity epidemic, has been reinforced by the amount of carbohydrate in a person’s recommended daily consumption being increased. There comes a time when we need to scratch our collective heads and wonder what on earth is going on, and how we can change in order to reduce obesity levels and save countless lives. Studies dating back seventy years ostensibly shed doubt on ancient dietary guidelines. However, any scientific study needs to be questioned; this is the point of peer reviewing of academic papers. This book clearly states that, however ingrained nutritional concepts are, in the light of the continuing obesity epidemic we should be questioning and re-evaluating them. Famously, the first words a medical student hears at medical school are ‘Half of what you learn here will be proved false in the future; the trouble is, we don’t know which half.’ Well, now we know a little bit about the false half: it is public health, government and dietetic dogma that is being proved to be erroneous, and it is up to fearless and skilled physicians like Aseem Malhotra to make some waves and overcome the views of dyed-in-the-wool traditionalists.

Hands up who knows what the Mediterranean Diet is? Well, think again. This brilliant book demonstrates the evolution of the concept ‘diet’, based on the ancient Greek meaning, referring to food, lifestyle and culture. Aseem Malhotra and Donal O’Neill trace the modern Mediterranean Diet back to its authors, Margaret and Ancel Keys, in a rather fond, nostalgic way, despite current scientific analysis demonstrating that much of Ancel’s work was flawed. But the particularly enticing element is how southern Italian lifestyle and culture are woven into the plot, along with the romance of food and the relaxed frame of mind and body inherent to the people of this beautiful coastline. The Mediterranean Diet never looked so tempting, comprising locally, naturally sourced fish, meat, vegetables, olives and more. One used to have to move to the Med, but not anymore. Now, you can bring the Mediterranean Diet into your own kitchen and incorporate it into your lifestyle. There is so much that modern advice and guidelines could do to improve the nation’s health, if it weren’t for the paranoia of public health bosses and the intransigence of traditionalist physicians in failing to change their ways.

One of the last great and sensible medical textbooks was written in 1951 by Raymond Greene (the novelist Graham’s brother). After this, falsehoods and misperceptions were peddled ubiquitously. Greene wrote, with regard to obesity:

Foods to be avoided:

1. Bread and everything else made with flour

2. Cereals, including breakfast cereal and milk puddings

3. Potatoes and all other white root vegetables

4. Foods containing much sugar

5. All sweets

You can eat as much as you like of the following foods:

1. Meat, fish, birds

2. All green vegetables

3. Eggs, dried or fresh

4. Cheese

5. Fruit, if unsweetened or sweetened with saccharin, except grapes and bananas.

This is the perfect advice for a healthy diet and to counteract obesity. The discarding of these excellent rules, and the total reversal by Public Health England, has underpinned the obesity epidemic over recent decades.

Science, and therefore clinical treatment, can advance only if clinicians such as Aseem Malhotra study the science behind current guidelines, question them, and change them as appropriate. This book is a fantastic example of a top clinician looking at himself in the mirror, realizing the faults of his profession and having the courage to blow the whistle, in the media, on what most doctors and nurses either misunderstand, or know to be true but feel unable to transmit to vulnerable patients.

Maybe the history of obesity will be defined by Hippocrates, Galen, Celsus, Sushruta, Maimonides, George Cheyne, Raymond Greene and Aseem Malhotra. If so, I will stand there beside him, supporting him in any way I can.

Aseem Malhotra is experienced enough to be able to thoroughly assess the evidence surrounding diet and disease and thick-skinned enough to battle the slings and arrows that have inevitably followed him, but given his knowledge, his views, his research and his powers of communication, we may actually be able to look forward to a brighter future with regard to obesity and rates of preventable death. Congratulations, Aseem and Donal, on a fearless and brilliant book that stands to dramatically improve the nation’s health.

Introduction

‘It is health that is the real wealth, and not pieces of gold and silver.’

– Mohandas K. Gandhi

As a qualified doctor for over fifteen years and a practising cardiologist who has treated thousands of patients in my career, including operating on hundreds with heart disease, I have come to realize that much of modern medical practice has become no better than putting a sticking plaster on a severed artery. For decades, our medical culture and resources have been misdirected towards treating the symptoms of disease and not directly tackling the root causes.

As a result of this failed model, healthcare is in crisis and we are all suffering. Over 60 per cent of the UK adult population are overweight or obese. More disturbingly, a third of children are in the same category by the time they leave primary school. And the trends are getting worse. The situation has become so grave that the UK’s chief medical officer, Professor Dame Sally Davies, has said this may be the first generation of children that is outlived by its parents.

The rocketing levels of obesity and the diseases associated with it has left no socio-economic class, age or demographic immune across the western world. It’s even affected the military. In 2012, the Surgeon General of the United States declared that obesity was now a threat to America’s national security.

However, obesity itself is just the tip of an enormous iceberg of chronic diseases driven by poor lifestyle, namely, heart disease, type-2 diabetes, cancer and dementia. In the United States, 75 per cent of over 3 trillion healthcare dollars are now spent treating these diseases; and they also lie behind most of the demand on the UK’s National Health Service.

And it’s not just our health services that are struggling to cope with this avalanche of illness. An unhealthy, unhappy society is also an economically unproductive one.

How have we allowed this to happen? Is it down to lack of personal responsibility? Could gluttony and slothfulness be eliminated, or substantially reduced by the simple educational message: eat less and move more? No – this is not the case; in fact, this is one of several fatally flawed messages which, in addition to making us sicker has also detracted from the introduction of truly meaningful solutions both for individuals and for the wider population at large.

Be prepared for everything you know and believe to be true to be turned on its head. Misguided public health messages and the marketing campaigns that push them continue to mislead doctors, the public and politicians, but it’s time for that to change.

The following chapters will explode several myths, including why you need to stop fearing saturated fat and cholesterol, why you must stop counting calories, why an ageing population is not really an issue and that you can drop dead healthy, why there’s no such thing as a ‘healthy weight’, and why sugar deserves its reputation as public enemy number one in the western diet. Once you understand the science behind this, you will be better equipped to commence and experience what will be the beginning of a life-changing journey taking just twenty-one days.

The Pioppi Diet combines and layers multiple ‘health positive’ lifestyle choices – of which food is but one – to fire up your body’s feel-good factor. While it is, generally speaking, the main determinant of health, the impact of better food choices will be magnified by making more informed choices in other areas of our daily habitual lifestyle. It is the combination of these factors that makes the Pioppi Diet uniquely powerful as a twenty-one-day health intervention. In simple terms, the Pioppi Diet is designed to help you tune into your body and recognize and respond to its requirements: food, sleep, movement, breathing and ‘exercise’ – which we prefer to call ‘mindful movement’. The result is a subtle but incredibly powerful demonstration of your body’s ability to lead you towards a leaner, healthier, happier and more energized you.

But don’t just take our word for it. We are privileged to engage the expertise and support of a multitude of respected international scientists, including cardiologists and obesity experts. With this, combined with our own experience and other personal testimonials, you can feel confident that the solutions of the Pioppi Diet are driven by the best available modern scientific evidence. This book is based on the 2016 documentary film The Big Fat Fix, which was co-produced by me and former international athlete and film-maker Donal O’Neill. The former Secretary of State for Health and current Mayor of Greater Manchester, Andy Burnham, has publicly recognized the film’s potential ‘to help millions and save thousands of lives’ – our ultimate and most important goal – and I would ask and actively encourage you to share the health secrets of the Pioppi Diet with family, friends and colleagues far and wide. Trust me, it is never too soon – or too late – to make positive lifestyle changes.

To quote a young editor of Men’s Health magazine who transformed his health and life by adopting these changes, ‘This stuff really works.’

1. Pioppi: The Village Where People Forget to Die

‘In Italy, in the Campania region, in the province of Salerno, in Cilento, in Pollica, we have a treasure.’

– Stefano Pisani, Mayor of Campania, June 2015, in an interview for The Big Fat Fix

Never have truer words been spoken.

In southern Italy, two hours south of Naples, there is a tiny village called Pioppi (population: 197). Every day, a handful of small boats leaves the picture-book harbour to fish for their designated catch. The fishermen’s bounty is more communal than commercial. The boats return with enough to sustain the community and the very small number of local restaurants. Each afternoon, all the people in this village (which doesn’t have a supermarket) retire for the traditional siesta. Local legend has it that the character of Santiago in Ernest Hemingway’s Old Man and the Sea (1952) was inspired by a visit by the author to the region. If you visit – as we did – you will find that very easy to believe.

After my father suffered a heart attack in 2010, I spent the following five years researching the ins and outs of heart disease and our modern diet. Not long before that heart attack, my dad had been congratulated when he sailed through his most recent cardiac stress test. ‘Are you an athlete, Mr O’Neill?’ he was asked. ‘Not any more,’ he replied. ‘But I was a long time ago.’

Like many households, we had replaced butter with ‘heart healthy’ margarine back in the 1980s. In one TV advert, fat was poured down a kitchen sink to demonstrate the operation of saturated fat in clogging your arteries. Not only was this a devastatingly effective visual, it carried an equally compelling – though ultimately misleading – message. My mum began to cook with ‘healthy’ sunflower oil, and full-cream was replaced with semi-skimmed milk in our house. We all feared fat.

That narrative would stay with me until 2010, when my research for Cereal Killers began. When we eventually stumbled over the line with that movie in 2013, Aseem embraced the movie and its message. He organized screenings in London and invited key medical and media figures to attend, and my appearance on BBC Breakfast with Dr Peter Brukner, the former Head of Sports Medicine and Sports Science at Liverpool Football Club and now team doctor to the Australian cricket team, was entirely his doing.

‘Don’t Fear Fat’ was the tagline to Cereal Killers. If it seemed an outrageous and rebellious message at the time (one national broadcaster was keen to commission a remake, ‘only with much less fat’), public feeling has shifted in the interim. When we pointed the camera towards athletic performance and to the remarkable Sami Inkinen for our follow-up documentary, Run on Fat, there was no grand plan to make a third movie. But then I read about Pioppi in Nina Teicholz’s excellent book The Big Fat Surprise, and I wondered if there was a story waiting to be told in this tiny, long-forgotten Italian village. When internet searches came up with nothing on the subject, I got very excited indeed.

It was June 2015 when we arrived, unannounced, in Pioppi to film The Big Fat Fix. The brief was to capture the very essence of a sleepy little village where the people forget to die. This proved to be straightforward on the one hand, but almost impossible on the other.

Where there was food, we would shoot it. When we enjoyed food, we would discuss it on camera. But in our bid to recover the true secrets of Mediterranean longevity, we were planning to go beyond food. Way beyond. As we opened our senses to invite the magic of this environment to seep into our bones, we came to identify and peel back those forgotten layers of lifestyle – the ‘treasure’ referred to by the mayor – which had been buried by decades of misinformation.

When I sat down to a seafood lunch on that first day with Aseem – by then my co-producer, co-author in waiting and leading global anti-obesity campaigner – I stopped thinking there might be a story and started to believe there might be much more than that. We both did.

The restaurant we chose to focus on was La Caupona, in the heart of the village, and the hospitality we enjoyed that afternoon set the tone for a remarkable stay in this magical place. We spoke no Italian, and the elderly gentleman who greeted, served and waved us goodbye spoke no English. His mode of communication was his enormous smile, but we nonetheless navigated our way to a remarkable feast of seafood, grilled vegetables and an abundance of olive oil.

As Aseem smoothly extolled the heart-healthy virtues of olive oil to the camera, Marek, the cameraman, salivated behind it. As a general rule, when the guy behind the camera is genuinely interested in what’s happening in front of it, you’re probably winning, so this was a good start. Like all good directors, our director, Yolanda, likes to plan shooting schedules carefully, but when nobody speaks English and you don’t quite know what you’re looking for in the first instance, sometimes you have to go with your gut. This is not how documentaries are typically made, of course, but it very often makes for a better film.

When Professor Tim Noakes referred to The Big Fat Fix as ‘exceptional. The best health movie ever’ and Aseem secured a worldwide premiere screening to members of the British Parliament in Westminster, we felt that we had successfully navigated our way to a solid end result. Of course, on our first day of filming, we had no idea that this was to come.

There was a lot we didn’t know.

After lunch, we drove around to familiarize ourselves with the area while the locals retired for their siesta. We would come to appreciate the potential – and very powerful – health significance of that cultural daily rite, but, like many of the lifestyle elements we identified in our time in Pioppi, it is impossible to isolate any one factor as an elixir of the remarkable health and longevity the people of this region have traditionally enjoyed.

When you read about the longevity research and ‘findings’ of those scientists who followed in our footsteps, we would urge you to take their recommendations of singularly magical longevity herbs with a pinch of sea salt. Our movie and this book recognize Pioppi as a very special place where impeccable traits of medical, nutritional and environmental science coexist, collide and combine with the physical wisdom of the very long-living in a perfect storm of human potential. The reality is simple enough. Science knows much less than we think and the people of Pioppi know a lot more than we have given them credit for – until now.

Pioppi is a place where time stretches, cradling you into a very compelling sense that not much matters beyond the minuscule borders of the village. The still and quiet of our first night there was a silent wrecking ball to our typical nocturnal environments. No noise. No lights. No disturbances of any kind at all. Just complete, idyllic serenity.

We woke the next day to a collective realization that our impromptu visit was becoming an immersion into something very special indeed. How to convert that into something tangible for the viewer was our next major hurdle. On that crisp, clear morning in southern Italy, it struck us that there was only one way to start that process.

Coffee.

The espresso bar in the centre of the village sits across the small open square from the restaurant where we had dined so well the day before. We successfully sign-languaged our way to espressos, cappuccinos and, in keeping with the plan, filmed the process. The science behind coffee as a health-positive habitual drink is increasingly compelling, so we needed some ‘cutaway’ visuals to back this up in the movie. If the coffee itself was magnificent, there was a much more powerful message awakening in each of us that morning.

Scientists don’t like to use the word ‘stress’ because it is not something they can accurately measure (the closest useable proxy is heart-rate variability (HRV), which we will discuss in more detail later). Although it is a very loose, catch-all term, ‘stress’ is something we each have an innate understanding of. We intuitively know when we ourselves, a family member, close friend or partner might be stressed and, over time, the implications of this on health can be profoundly deleterious.

The gut can respond very adversely to an increase in stress hormones, becoming more porous and effectively opening the door to invite illness in. While some experts in the field firmly believe that chronic stress is more damaging than even poor dietary choices in the long term, the one thing everyone agrees on is that less is much, much more when it comes to stress – pretty impressive for something we can’t even ‘measure’ accurately.

Within twenty-four hours of arriving in Pioppi, as Aseem and I enjoyed looking out to sea while sipping our espressos, bathing in morning sunshine and pondering the treasure beneath our feet, we agreed that there was something intangible but very powerful in the air. The complete absence of stress as we perceive and experience it in a modern, urban environment was as clear as our view of pollution-free sea softly lapping the pristine pebbled beach below us. Pioppi may lie in a historically poor region of Italy, but its health bounty is rich, plentiful and unadulterated.

No gym. No supermarket. No problem.

In the 1970s, decades before the internet would suggest it might be possible, would it have been conceivable that this tiny village could assert a greater influence on global nutritional and health policies than anywhere else on the planet? The fact that it did just that is what brought Aseem and me to this remarkable place that morning. We were retracing the footsteps of the American scientist Professor Ancel Keys.

When he visited the region after the Second World War (he had, famously, invented the K-ration, a portable, non-perishable ration containing enough calories to sustain a soldier for up to two weeks), Keys was so taken with Pioppi that he would return years later, to conduct the research that has ultimately framed our modern, albeit skewed, interpretation of the traditional Mediterranean lifestyle. As the architect of the modern ‘Mediterranean Diet’, Keys and his wife, Margaret, would live and work among the people of Pioppi for four decades before his death in 2004. His name is still spoken with reverence and no short measure of affection there.

Road signs as you enter Pioppi from either side paying homage to Keys and the village’s UNESCO-acknowledged status as the home of the Mediterranean Diet assured us that we were on the right trail. The official Mediterranean Diet Museum in an historic old building in the centre of the village satisfied us entirely that we had found the source of the greatest diet ever sold.

Pioppi booms in August as a destination for Italian holiday-makers but positively slumbers outside that small, blisteringly hot window. In the month of June, we figured the population of 197 would have immediately noticed the appearance of a camera crew in their midst. All we needed now was a means of communication more audible than the chorus of smiles which greeted us everywhere. Yolanda always says that a camera in public brings a sprinkle of magic with it. You never know who or what might present itself.

Angelo Morinelli was enjoying his morning espresso when a six-foot-five-inch cameraman appeared over his shoulder to capture the barista and the crema in close-up. He did not know that the man outside enjoying an espresso was Aseem Malhotra, a British cardiologist heading up a global campaign for lifestyle medicine. He would not have seen Cereal Killers either, but he knew enough to know that something was happening here.

And that he could probably help.

With no common language at our disposal, Marek’s pidgin German saved the day, and he formally introduced us to the man who had been Ancel Keys’s personal driver. It transpired that Angelo’s father had owned the land where Keys would build his villa and, later, the complex he used to accommodate visiting scientists – Minnelea.

Angelo excitedly made a call and passed the phone to me. His son, Antonio, had recently returned home to Pioppi after a decade cooking in the US. As an ambitious young chef, he had been determined to open a top-quality restaurant in his home village. That was the dream: a tribute to local produce in the UNESCO-protected home of the Mediterranean Diet.

For the remainder of our time in Pioppi, Antonio would become our guide, our host and our friend. That evening, we ate in his restaurant, Suscettibile, for the first time. His dream had become a splendid reality. The fact that Suscettibile would excel anywhere in the world will surprise no one who has had the opportunity to dine there. There is love of place and produce and artistry on every plate. The buffalo mozzarella from the region is sublime, the seafood incomparable and the wine – ah, the wine!

That was the night we met the magnificent ‘meditation’ red. Antonio encouraged us to do so and then scheduled a visit to the magnificent San Giovanni winery to appreciate this local Mediterranean marvel. To see vines dive perilously down towards the sea with Pompei imperious in the distance sounds as improbable as it, in truth, appeared to the naked eye. If the camera struggled to capture the surreal beauty of this place, the wine did not. Ida Budetta explained how she and her husband had initially tilled this small plot of land with their bare hands. The term ‘organic’ means nothing here. There is just the land. And the sea. And the people’s love of what they do. If the relationship with the land and its produce is one of mutual respect, this reflects a critical, forgotten aspect of the traditional lifestyle in this region – the work.

Antonio also arranged, and joined us for, our interview with Mayor Pisani. In one brief soundbite, the mayor explained in very simple terms where it had all gone wrong in the modern interpretation of the Mediterranean ‘diet’. In a catastrophic case of ‘lost in translation’, the original greek word diaita had been misunderstood at its source. Diaita means ‘lifestyle’, and ‘within that,’ Pisani said, ‘we include many things – the landscape, the sea, quality of life, culture, the work and many other things.’

In this region, the men, who work for eight hours a day, every day, in the fields, their entire adult life, outlive the local women. They outlive their peers around the world by almost a decade. These men joked with us about the intensity of chopping wood; it is part and parcel of their daily tasks. ‘Try it for an hour,’ they said, laughing. The ‘work’ the mayor referred to meant decades of slow, constant, habitual movement (walking) along with more intense, strength-maintaining bursts of full-body activity (wood chopping, and so on). Could it be a contributing factor to their longevity?

As we sought to marry the latest scientific research with the wisdom of this place and these people, the importance of movement and mobility became apparent. If the research aligning mobility with ten-year mortality rates (death from any cause) points to the importance of strength, balance and power as we age, the men of Pioppi need not worry.

The fact that science measures only that which it can – and, typically, only at acute points in time – and that modern medicine is essentially the business of illness management has created a vacuum in our understanding of how to truly live well. Healthy people do not interface with modern medicine in the same way as sick folks, if at all. While vast resources are ploughed into understanding, diagnosing and treating illnesses, the healthy are left alone to get on with living without illness. However, all bets are off when they reach a hundred or achieve some remarkable feat, at which point everyone suddenly wonders what they did to get there in the first place!

The power of myriad health-positive lifestyle choices (conscious or otherwise) such as those contained in a traditional lifestyle in Pioppi goes unnoticed until longer-term population trends emerge. Science then scurries to understand retrospectively how these people are consistently winning the longevity Olympics.

And they do not just live long, they live well.

If ageing is seen as a process of gradual physical deterioration, then the traditional people of Pioppi clearly accumulate the slings and arrows of that process more slowly than many of us. For example, it did not strike us as at all odd when we noticed our waiter from that first day helping to fix the roof of his premises one morning. When Antonio later informed us that he was eighty-five years old, we decided it was damned impressive. That his movements were fluid and trouble free certainly belied his chronological age. Unfortunately, our enthusiastic bubble was quickly burst when he then told us about another Antonio, the oldest man in the area, having reached the ripe old age of 107! While eighty-five might be considered an excellent innings anywhere else, our waiter was but a spring chicken in this village where the people forget to die.

So how exactly do they do it? The truth is, we will never be able to explain fully why these people live so well for so long, but we can certainly present the case for some authoritative guiding principles.

During an excellent tour of the Mediterranean Diet Museum in Pioppi with local English-language teacher Susan Bessie Haslam, it was pointed out to us that poverty would have exercised a strong impact on the traditional way of life in this region. Day to day, that meant restrictions on the availability of food and imposed windows of restricted eating. In this context, Antonio explained how the men would have gone to work the fields on an empty stomach on such occasions. Of course, we now know that fasting is a rising star in the treatment of type-2 diabetes and that bodybuilders have been using intermittent fasting protocols as a mechanism to manipulate lean muscle mass for some time now. It may not have been intentional, but intermittent fasting was a natural part of a traditional life in this region.

Although Ancel Keys’s original research never accounted for periods of fasting or abstinence for religious or other reasons, it was a very real phenomenon across the Mediterranean after the Second World War. Just as the work would have contributed to the health benefits of the traditional diaita, so, too, the intermittent absence of food would have bestowed further marginal but meaningful gains for population health in the region. More on that later.

Like in a cryptic crossword, the clues to longevity were slowly presenting themselves everywhere we turned.

With hindsight, one can now see how the case for a super-simple interpretation of a much broader, potently health-positive lifestyle gathered momentum and credibility, first with Keys’s researchers and, subsequently, with those policy-makers in the US who butchered the diaita through the prism of food politics in the 1970s.

The Pioppi Diet is a translation of what the governing lifestyle principles of a traditional Mediterranean diaita might look like in the context of a modern western lifestyle. Whether you are in New York, London or Sydney, we trust you will enjoy your own journey to better cardiovascular, physical and mental health and longevity.

In the chapters ahead, you will learn more about the root cause of modern lifestyle diseases, including heart disease, obesity and type-2 diabetes. We will explain why exercise has been overrated – and movement underrated – as a weight-loss mechanism; what telomeres are and why effective stress management is a critically important tool to protect them; which foods can radically impact on your body composition, energy levels and cardiovascular health. Most importantly, you will be given a clear set of guidelines and an easy-to-follow, Pioppi-influenced prescription for better health that will dramatically reduce your risk of heart disease in just twenty-one days.

If you can’t wait to get started on that plan, you can jump right ahead to Chapter 14. A word of warning, though! When your family, friends and colleagues ask why you’re looking and feeling so good in three weeks’ time, you may have to circle back to understand what exactly just happened. Then again, you could just tell them, ‘It’s all about Pioppi.’

If the future of healthcare is lifestyle medicine, then Pioppi was way ahead of its time!

PENGUIN BOOKS

The Pioppi Diet

DR ASEEM MALHOTRA

DONAL O’NEILL

Dr Aseem Malhotra and Donal O’Neill

THE PIOPPI DIET

PENGUIN BOOKS

Contents

Foreword by Professor David Haslam, Chair, National Obesity Forum

Introduction

Part One

THE STORY AND THE SCIENCE

1.

Pioppi: The Village Where People Forget to Die