British Cardiologist, Dr. Aseem Malhotra, is making waves in the area of heart health and everything we hold to be scientific fact on the subject. While researching and filming for his documentary, The Big Fat Fix, in Pioppi, a small region in Southern Italy, he was shocked by the comparison of its people’s diets, lifestyles and overall longevity to the U.S. as well as most modern societies around the globe. The people of Pioppi have an average life expectancy of 90 years old, and many live to be over 100. He noted that they aged well, without chronic illnesses or heart disease, lived longer than major athletes without participating in prescribed exercise, and still ate a diet similar to what their ancestors ate.
In his new book, The Pioppi Diet: A 21-Day Lifestyle Plan, Dr. Aseem Malhorta unravels the secrets of the Pioppi lifestyle, while revealing the misconceptions and revised truth of heart disease, along with a dietary plan based on the Pioppi people. Read on for the full interview with Dr. Frank Lipman as he gains insight into Dr. Malhorta’s approach to heart health, his prescribed diet, and how to live like the Pioppi.
Dr. Lipman: When most think of an Italian diet, it includes lots of carbohydrates, bread, and pasta. How does the Pioppi diet differ?
Dr. Malhotra: First of all, chronic diseases from heart disease, high blood pressure, dementia, cancer, and type II diabetes are all linked to insulin resistance. We should rename to the ‘carbohydrate intolerance disease.’
In Pioppi, pasta, bread, rice and potatoes are not eaten as the main course. They are starters. They consume very little sugar, and desserts are eaten only once a week as a special treat.
In the U.S., pasta is typically the main course, lots of sugar is used. Even the bread we are eating is very different than what we were eating 50 years ago – they would take time and bake their own bread, and spend more than 24 hrs making it. Today it’s very high glycemic index bread with sugar added to it. It’s a different animal.
Advice – go cold turkey for 21 days off these processed carbohydrates. See how it affects you. It’s quite remarkable. I’ve had patients go off pills, feeling better, losing weight with very simple lifestyle changes made very quickly and easily.
FL: You are quite outspoken when it comes to the benefits of cholesterol or that cholesterol is not the devil. Can you explain? Also, what are the downsides to statins?
AM: Science evolves. Before I go on to explain the cholesterol issues, we have to accept one thing. David Sackett, the father of evidence based medicine, once said:
50% of what you learn in medical school will turn out either dead wrong or outdated within 5 years of graduation. The trouble is you don’t know what half and must learn on your own.
And what I’ve learned about cholesterol, and what is a real u-turn from what we learned in medical school, and when you look at the totality of the evidence is stop fearing cholesterol. High cholesterol, in its own right, unless it is extremely high, we’re talking about – in the uk we have levels of over 10, let’s take LDL over 190 (most people don’t have an LDL nearly close to that), then the original studies from Framingham (which is where we got the risk factor for cholesterol), show there was no strong association unless it was extremely high or with heart disease. And what we know now as well – I was involved in some research published in the BMJ the last year where we looked at populations aged over 60 years old specifically looking at LDL cholesterol and its association with heart disease. What we found was pretty extraordinary –
There was no association with heart disease and in fact there was an inverse association with all cause mortality. So how do we explain that? The Decade-long campaign to lower cholesterol to beat heart disease has failed because it’s a flawed hypothesis.
Cholesterol is a very vital molecule in the body. It’s involved in the immune system, it’s important for hormone production, maintaining the integrity of cell membranes, neurological function, and the explanation for why elderly people probably live longer with higher cholesterol than people who don’t have have high cholesterol is likely due to the involvement with the immune system and the protection from life-threatening infections like pneumonia. So we have to completely change our view and how we look at cholesterol.
You Asked about Statins. Many people think statins are a miracle drug. There are 30 million people in the USA, 100 million worldwide, taking them. First thing to acknowledge and most doctors don’t really know this – is almost all the data on statins have been sponsored by the drug companies. Take them with a grain of salt because we know they are going to exaggerate the benefits and minimized the side effects. The people in the trials were highly selected so these were people who able to adhere to the drug based on different characteristics. Before the drug trial those who didn’t tolerate the drug were taken out of the study group.
But even then, what does that data tell us? If you have had a heart attack, if you have established heart disease, then taking the drug every day, for 5 years, there is a 1 in 83 chance that it will delay or prevent your death and a 1 in 39 preventing a recurring heart attack. If you have never had a heart attack, if your not at high risk of heart disease (75% in this country fall into that category), independent analysis says you will not live one day longer taking a statin. Most people don’t know this.
I’m not against statins per say, I’m against lack of transparency in medicine, and their prescription. It’s for doctors to give this information to patients and up to the patient to make a choice to take a pill everyday and this is before we even get into side effects issue. It’s now established more recently that statins do cause type II diabetes in about 1 out of 100 people taking them and there are lots of other side effects I see with my patients, and I have prescribed statins to thousands of people in my career. The side effects interfere with quality of life, and probably affect ⅓ of people.
What is there perception of statins when it comes to lifestyle? So for many people it gives them the illusion of protection. I’m taking a statin, I can go gorge on junk food. It’s an issue we need to address.
FL: What are the key points to the lifestyle changes you suggest?
AM: When it comes to food. Concentrate on components of the Mediterranean diet which are thought to be anti-inflammatory. Those are – extra virgin olive oil, a handful of nuts everyday, oily fish (ideally wild fish if you can), lots of non-starchy vegetables (those should be the core of the diet), cutting out processed foods. No snacking, very little carbs, no refined carbs. Begin to look at them as a treat, not something you should have regularly. The same goes for sugar.
When it comes to the other aspects, in terms of lifestyle, we need to change the word ‘exercise’ and talk instead about mindful movement. Not sitting for more than 45 minutes at a time. Can you just walk for 30 minutes 5 times a week?
And Stress and the energy component! How do you feel? How do you sleep? Are you sleeping at least 7 hours a night? If not why not? And stress, are you doing things to counteract it? Are you engaging in meditation? Yoga? Pilates? Simple things that can have a dramatic affect on your wellbeing.
For more information on Dr. Aseem Malhotra and his research visit his site, here. Click on the image below to order his book, The Pioppi Diet.