In case you’ve already mentally filed this interview with Dr Aseem Malhotra, cardiologist and co-author of The Pioppi Diet, under “too long; didn’t read”, let us answer the headline for you. It’s because you don’t live in a somewhat poor Italian village, have to walk everywhere, don’t have access to junk food and sometimes don’t have enough to eat. If you do live in those conditions, there’s nothing wrong with eating pasta in the traditional Italian way, as a starter, Malhotra told us.
That’s just one of the ways the Pioppi Diet can be a bit confusing, just ask the Amazon reviewer who was disappointed not to get an Italian recipe book. So while we’ve already summarised the Pioppi Diet for you, and asked a dietitian to comment, we spoke to Malhotra to let him make his pitch.
In our conversation, Malhotra emphasised he’s very interested in public policy that addresses the obesity epidemic and its impact on rates of heart disease and type 2 diabetes, and slammed the junk food industry a number of times. He even said, “I’d rather this book sell 10,000 copies and have a big impact on changing policy than selling a million copies and that not happen.”
But we’re assuming you’re not in a position to enact a sugar ban, so we’ve edited and condensed our interview to focus on what the plan asks you to do and why.
What is the book trying to achieve?
The book tries to bust myths and ties it together with modern medical, independent science that tells us where the focus should be when beating heart disease, type 2 diabetes, obesity and other chronic diseases.
One of the root causes driving this epidemic has been misguided dietary advice. There has been an obsession with cholesterol and the side effect has been that we’ve increased consumption of sugar and refined carbohydrates.
There’s also been a lot of misinformation around exercise. For a long time people thought, myself included, that a lack of exercise was a big factor to blame for obesity, when in fact the reality is exercise does very little when it comes to weight. Of course it’s very good for health, but when it comes to weight almost all of it is being driven by poor diet and consuming the wrong type of calories.
Is the Pioppi Diet relevant to everyone or is it only relevant to people who are obese, or at higher risk of heart disease?
It’s relevant to everyone. Up to 40% of people who have a so-called normal body mass index will suffer from lifestyle-related diseases.
People who are overweight and obese will improve their health markers and are likely to lose weight as a side effect, but the focus of the Pioppi Diet is more about health.
What are the main elements of the Pioppi Diet?
We identify the types of foods that people are consuming that, certainly in excess, are going to cause harm in the long term. The obvious one is junk food, but specifically refined carbohydrates and sugar, which has the biggest impact on glucose and insulin responses in the body. Over time, if you’re eating foods that are going to spike your glucose to high levels then you are going to increase the risk of developing insulin resistance, which drives many of these chronic diseases – it’s the number one risk factor for heart attack, it’s responsible for about 50% of people with high blood pressure and certainly it’s a precursor of type 2 diabetes. It’s also independently associated with many cancers as well and probably also linked to dementia.
So it’s about eating less of those foods. The plan emphasises where the best evidence is from clinical trials in terms of the types of food that are going to be beneficial for your health. So that means lots of vegetables – preferably non-starchy, fibrous vegetables – extra virgin olive oil, handfuls of nuts and oily fish.
I think we also need to avoid snacking, because it’s something we’ve produced in the modern era. Really it’s just a ploy by the food industry, understandably, to sell more food.
The other elements are walking briskly for at least 30 minutes a day and not sitting down for long periods of time. It’s probably much better to make sure you’re walking throughout the day, moving around and not sitting down, than driving to the gym, doing a 5K run for 30 minutes and then sitting down in an office for the rest of the day.
Stress is important too. It’s very hard to objectively measure stress but we as individuals all know when we’re stressed and that ties in to getting enough sleep – aim for at least seven hours of sleep a night – and how we interact with each other. Spending time with friends and family rather than spending lots of time on social media, for example. We know that if you have a good sense of community and good relationships, that mitigates a lot of the external life stressors that we experience.
If people do these things the impact on health is very quick. The reason we’ve got a 21-day plan is that those health markers improve [in that timeframe] but you’re also on the road to better health in the medium to long term.
I couldn’t help find it slightly ironic that a diet plan named after an Italian village suggests restricting pasta because it’s a refined carb. Why is that?
Traditional Italian diets never had pasta as a main course, they eat pasta in small amounts as a starter, and they had two to three meals a day.
The amount of refined carbohydrates compared with the modern Western diet was much less and there was very little added sugar – dessert was eaten once a week on a Sunday. When you haven’t got insulin resistance, I don’t think there’s a big issue of people eating small amounts of those refined carbs as long as they’re getting all the other good stuff in.
In the book we talk about the secrets of this village but we tie this in with modern scientific evidence when it comes to type 2 diabetes and all these other chronic diseases.
So for the 21-day plan we want people to completely restrict refined carbs and added sugar, just to see how they respond. You can tell people to eat less, but you can’t tell people to stop feeling hungry. But refined carbs and sugar are types of foods that don’t satiate you because they’re of poor nutritional value and the way that they affect insulin also has an impact on hormones that control appetite as well.
Many people find that once they’ve broken the so-called sugar and refined carb addiction cycle they can get by on two or three meals a day and not have this crash mid-afternoon after having a refined-carb-heavy lunch.
After 21 days ask yourself how you feel. Perhaps you’ll start to see those sort of foods more as the occasional treat rather than something you need to have and consume on a daily basis.
Within the plan you recommend fasting days. Why?
That’s something we recommend people do in the 21-day plan once a week. There is some good evidence emerging that fasting is a very powerful tool for reducing insulin resistance. We do it in a way where you never go to bed hungry. You eat a normal evening meal one day, then don’t eat anything that has calories until the following evening, so there’s a 24-hour break.
Do you recommend that people continue to do that after the 21-day plan?
Well I think there is a bit of a nuance here. If people can sustain and do it once a week, then great. If not, then as long as they’re doing the other stuff, they’re still going to have a big impact on their health.