One of the first surgical procedures I observed and assisted in as a qualified doctor was the amputation of a patient’s lower limb due to complications from type 2 diabetes. Sadly, the incidence of such amputations continues to escalate in the UK – last year a staggering record high of 8,500 patients were subjected to amputation procedures directly caused by the complications of diabetes with type 2 diabetes making up 90 per cent. When I see a patient, it is professional experience and statistics such as these that inform my work as a practicing cardiologist.
If heart disease is our biggest killer, the latest research points to the root causes of inflammation and insulin resistance (a precursor to type 2 diabetes) as the greatest challenge in modern healthcare. It is the systematic failure to acknowledge the root cause of these metabolic diseases and inform the nation expediently and effectively that has wrecked havoc with the health of the British people.
Several years ago I committed to take a firm stand against this epidemic of misinformed doctors and misinformed patients in my own quest to separate scientific fact from science fiction. In fact one of the founding fathers of the evidence based medicine movement, the late Professor David Sackett said ‘half of what you learn in medical school will turn out to be either outdated or dead wrong within five years of your graduation. The trouble is no one can tell you which half so the most important thing to learn is how to learn on your own‘.
My first book ‘The Pioppi Diet – A 21 day lifestyle plan’ which I co-authored with filmmaker and former athlete Donal O’Neill, is simply the latest chapter in a campaign to set the record straight. Since its release in July of this year, The Pioppi Diet has generated intense public debate on one side and – most importantly – better health markers and quality of life for adherent readers on the other. To be clear, I welcome both. Informed debate is the lifeblood of constructive medical and scientific progress and readers like Lynda and her husband who recently wrote a short note to thank me for ‘a life changing book’ are now ambassadors for better health in their own family and community circles. Given the chance, good health can go viral.
Regardless of the proven metabolic health benefits of The Pioppi Diet, the substance and title of the book has invited distorted criticism, so let me address that.
The book is named after the southern Italian village of Pioppi, the UNESCO anointed home of the Mediterranean Diet. Donal and myself travelled there for the first time in 2015 to research and film the documentary film ‘The Big Fat Fix’ (upon which the book is based). The film and now the book examine and critique the work of the influential American scientist Ancel Keys who conducted much of the original Mediterranean Diet research from his villa in Pioppi. That research began before England won the World Cup (soccer, not rugby!) and culminated in a skewed interpretation known as the ‘Food Pyramid’ in the USA, compiled by a government administrator in the 1970s.
The first key point to note here is that the ‘generally accepted’ Mediterranean Diet is essentially a 1970s interpretation of the traditional Mediterranean ‘Diata’. When we met Stefano Pisani, the mayor of the region, he informed us that the word diata was traditionally used in reference to the myriad lifestyle components of the region – not just the food but the work in the fields, the social bonds ‘and many other things’. It was clear to us that much had been left behind, forgotten or (intentionally or otherwise) completely disregarded in compiling the modern interpretation of the Mediterranean Diata. We set out to correct that.
The Pioppi Diet is a lifestyle plan designed to mimic the principles of a mid 20th century lifestyle in today’s urban jungle, of which food is one integral component. Just as the generally accepted version of the Mediterranean Diet is one interpretation of the diata, the Pioppi Diet is ours. We have married the additional pillars of health and longevity we identified on the ground through our local research amongst the residents of Pioppi with the latest scientific data in the fields of nutrition, exercise, movement and medicine. These principles are summarised in an editorial published in the British Journal of Sports Medicine I co-authored with two eminent international cardiologists (both editors of respected medical journals) in a call to shift the paradigm of what causes heart disease but also emphasise that it’s risk can be rapidly reduced from simple lifestyle changes.
We conclude that there is no business model or market to spread these simple yet powerful interventions.
The Pioppi Diet encourages an increase in habitual movement, an optional but highly effective exercise and mobility protocol, better sleep, stress reduction techniques and social activity – all of which are proven to benefit health outcomes independently. We also advocate high quality protein sources, abundant vegetables, a lower intake of refined carbohydrates and a higher intake of fat (2 to 4 tablespoons of olive oil and a handful of nuts daily are foundational fundamentals) than the generally accepted version of the Mediterranean Diet. Why? It has of course been proven that the generally accepted Mediterranean Diet is superior to the standard UK or American diet for metabolic health, but studies including a higher fat Mediterranean Diet option actually outperform the ‘generally accepted’ version.
In its totality, The Pioppi Diet is an up to date evidence based, superior version of what is already considered a good diet. It is a change for the better. That is why the book enjoys endorsements from the chair of the medical royal colleges, the former personal physician to her majesty the Queen, eminent Cochrane researchers, dieticians, and nutritionists. It has received a number of resoundingly positive reviews in a number of medical journals including one from the former chair of the Royal College of General Practitioners. That is why readers like Lynda see real results. That is why the book has been a bestseller in the UK. That is why the mayor of Manchester, Andy Burnham, has said that The Pioppi Diet has the ‘power to make millions of lives healthier and happier and help sustain our NHS’.
I would rather sell 10,000 copies and have an influence on policy than sell a million and have none. As we make clear in the book the evidence reveals that policy changes that curb the obesogenic environment – and make the healthy choice the easy choice – will have a far greater impact on population health than education alone.
That is why the most vocal and influential politician in the past few years advocating for sugar reduction in the UK, Keith Vaz MP, himself a type 2 diabetic in parliament called on 100 MPs with the highest prevalence of the condition in their constituencies to follow the plan over the summer.
And the financial toll of failure to deal with high sugar diet (we advise going cold turkey on all added sugar for the first 21 days) has been predicted by one investment bank to reach close to 0 per cent economic growth in OECD countries by 2035. An unhealthy population is an economically unproductive one.
It is therefore puzzling that last week That Pioppi Diet was named by the British Dietetic Association in a list of Top 5 worst celeb diets to avoid in 2018.
In response one leading GP publicly called them out on twitter for their criticism of the book as ‘disgraceful and inexcusable’ and ‘an attempt to mislead the public’. One prominent Psychiatrist, member of the BMA board of science and chairman of the British Association of Physicians of Indian Origin Dr. JS Bamrah said ‘The BDA have shown their ignorance attacking anyone for trying to reduce risk of diabetes’.
Business Insider referred to the British Dietetic Association as being a ‘top authority’ in their ripping to shreds of the Pioppi Diet amongst others. I hadn’t realised the BDA were experts in the causes of heart disease and type 2 diabetes?
As Albert Einstein once said ‘a foolish faith in authority is the worst enemy of truth’.
In their press release The British Dietetic Association made a blatantly false statement that we imply coconut oil is part of the Mediterranean Diet when it featured in a section of Aseem and Donal’s top ten foods, it was never part of Pioppi and we never come anywhere close to claiming it to be so. In keeping with the evidence we identify what foods that have been consumed in the Mediterranean are ones that are likely to have anti-inflammatory properties that would explain the decades low incidence of heart disease in the region. We encourage as we do to make that the base of the diet which includes preferably lot of non-starchy vegetables, extra virgin olive oil, a handful of nuts and oily fish and for the first 21 days to completely avoid the foods which not only have the least nutritional value but also whose excess consumption of has the greatest adverse impact on metabolic health. These include all refined carbohydrates such as added sugar, bread, pasta, rice and potatoes and for those who are insulin resistant, overweight or obese to then make these foods the occasional treat, not a daily staple.
In fact such a diet plan has already been advised by a free website which we reference, Diabetes.co.uk, whose own recent data on those reversing their type 2 diabetes and coming off medications without calorie counting is quite extraordinary and contradicts what we learnt in medical school that type 2 diabetes is a chronic irreversible condition.
As made crystal clear In the book the villagers of Pioppi never ate pasta as a main course, it was always a small starter, bread was freshly baked in the home and this of a much lower glycaemic index than modern bread. Pizza was eaten once a fortnight and sugar as dessert only on Sundays. For someone who is not insulin resistant, this dietary pattern with no processed food or snacking and an active lifestyle is unlikely to be harmful and clearly wasn’t for these southern Italians.
Another of many distortions of the book was made in an article by Christopher Snowdon, who said that he is yet to meet a dietitian who ‘endorses Malhotra’s message’, failing to acknowledge two eminent international Dietitian lecturers, both with doctorates who also peer reviewed and endorsed our eating plan.
In the end, The Pioppi Diet is a story of wisdom, tradition and science with a happy, healthy ending for the adherent reader. Clearly it is not enough for some to know that this book can save limbs, lives or both, but as a cardiologist, it is enough for me.