Vital Aging

The Pioppi Diet

For a few months now, the book the Pioppi Diet has been on the bestseller lists. What does the Pioppi diet entail? How does it compare to the Mediterranean and primal diet

Pioppi is a small village in southern Italy with a population of 197. People there have a simple, but also long, healthy life. There is neither a supermarket nor a gym. Residents eat good and healthy food, and enjoy a glass of (red) wine every day. The book The Pioppi Diet contains a lifestyle plan based on this that, according to the authors, improves health in 21 days and reduces the risks of type 2 diabetes and cardiovascular disease, among other things.

The authors are cardiologist Dr. Aseem Malhotra and documentary filmmaker Donal O'Neill. Together they previously made The big fat fix, a film shot in Pioppi. The Nutrition Center argues that no scientific studies have been done on the health effects of the Pioppi diet and its long-term consequences. Moreover, the Nutrition Center is particularly concerned about the restriction of carbohydrates and the wider use of eggs, red meat and (saturated) fats, including coconut oil. [1] What exactly does the Pioppi diet entail and how did Pioppi get on the map?

Pioppi and Keys

This village first became famous because nutrition researcher Dr. Ancel Keys lived there for forty years (until his death). His research on dietary habits in this village formed the basis of the modern Mediterranean diet, which he put on the map worldwide. Furthermore, Keys became known for the Seven Countries Study [2], a study that linked saturated fat to the risk of cardiovascular disease.

In their book, the authors of the Pioppi Diet refute these findings on saturated fat, writing in their book that Keys' research "provided the basis for our modern but misinterpreted traditional Mediterranean diet. In doing so, they also go against the Nutrition Center who indicate that the scientific consensus is still that replacing saturated fat with unsaturated fat lowers LDL cholesterol and thus reduces the risk of cardiovascular disease. [3] We also think differently about this from the primal diet, and will come back to this.

What does the Pioppi diet entail?

First of all, the Pioppi diet is called a lifestyle plan, which includes not only dietary guidelines, but also living rules for adequate exercise, relaxation, sleep, social contacts. Regular fasting is also recommended. The dietary recommendations assume a low carb, high fat diet, with components of a Mediterranean diet.

Malhotra and O'Neill's food top ten includes high-fiber vegetables, fruits, oily fish (at least 3 times per week), unsalted nuts (handful per day), extra virgin olive oil (2 to 4 tablespoons per day), coconut oil, dark chocolate (at least 85%, maximum 30 grams), whole fermented dairy (Greek yogurt, cheese, kefir and grass-fed butter), eggs (at least 10 per week) and finally herbs and spices, such as garlic, ginger, turmeric and basil. Red meat is recommended on a limited basis, a maximum of 500 grams per week, and preferably unprocessed and from grass-fed animals. Furthermore, in terms of drinking, coffee, tea and water are recommended and red wine (in moderation, one glass per day).

Carbohydrate-rich products with a high glycemic load are not recommended. Consider all products with added sugars, sodas, fruit juices, honey and syrups and all packaged processed carbohydrates, such as bread, pastries, pasta, couscous, rice, cookies, granola bars, etc. The same applies to oils from seeds such as sunflower, corn or soybean oil. By the way, legumes are not explicitly mentioned but do appear in various recipes

Differences from the Mediterranean diet

The Pioppi diet, by avoiding grain products and adding products such as coconut oil, is not a typical Mediterranean diet. In summary, the traditional Mediterranean diet also includes lots of vegetables, fruits, fish, olive oil, and some cheese, meat, nuts and egg, and is supplemented with pasta, rice and bread. So this diet is not low-carb, and that is perhaps the main difference between it and the Pioppi diet. In fact, it can be called a carbohydrate-restricted version of the traditional Mediterranean diet.

How does the Pioppi diet compare to the primal diet

Agreements:

- One major similarity is that both diets in summary consist of: (fatty) fish, seafood, eggs, seeds, nuts, vegetables, fruits, herbs, spices and healthy fats from vegetable oils, such as olive oil and coconut oil. Another similarity is that both diets discourage grains, processed, carbohydrate-rich products and (added) sugars.

- Both diets see the health benefits of saturated fat [4], and indicate that rather a diet with an excess of fast carbohydrates can lead to cardiovascular disease. This is contrary to what Keys published in his Seven Countries study, and what the Nutrition Center, as noted above, still indicates. (Read more about the role of saturated fats in the article: Coconut oil, healthy or not?

- Both diets use intermittent fasting. The Pioppi diet recommends 24 hours of fasting per week, and a maximum of three meals per day for the rest of the week. The primal diet is a bit more flexible and recommends varying the number of meals per day from 1 to 3, with a maximum of 17 to 21 per week. The primal diet also recommends leaving at least 13 hours between the evening meal and breakfast, and exercising sober first and then eating.

Differences:

- For various reasons, the primal diet discourages eating nightshade products, legumes and dairy as much as possible. Casein, lectins and saponins (and gluten from grains) in particular can irritate the intestinal wall, contributing to digestive discomfort. The Pioppi diet does not mention these substances. Although, even in the primal diet, these foods can be eaten occasionally, provided a person has a healthy digestive system.

- The same applies to mammalian meat: it contains Neu5Gc, a protein similar to human Neu5Ac, which can confuse our immune system. Again, it can be eaten in moderation within the primal diet, provided a person is healthy and exercises sober (then Neu5Gc is used as an energy source). The Pioppi diet is a bit more generous in its guidelines here and, as indicated, recommends a maximum of 500 grams from grass-fed mammals.

By the way: the Voedingscentrum states on its site that the Pioppi diet does not put a maximum on the amount of meat, which is not true (see note [5]). Although the Voedingscentrum also recommends eating a maximum of 500 grams of (preferably unprocessed) meat per week, of which no more than 300 grams comes from red meat.

Summary and Conclusion

The primal diet according to studies and the Pioppi diet have many similarities, both limiting carbohydrates, and opting for a menu with plenty of vegetables, fruits and healthy fats from fatty fish, eggs and olive oil. The Nutrition Center is particularly concerned about the restriction of carbohydrates and the wider use of (saturated) fats, amount of eggs and coconut oil in both diets. Although, according to the Nutrition Center, it has not yet been sufficiently scientifically researched, the diet does fit into a series of low carb, high fat diets, which have many health benefits.

By the way, the book The Pioppi Diet ends with a long bibliography, when many scientific sources are listed. [6]

The primal diet does go further than the Pioppi diet in avoiding some product groups, think nightshade, legumes and dairy. Now, the Pioppi diet is also more of a general lifestyle plan, whereas the primal diet, according to research, is the basis for restoring digestive (and overall health) health - also along with lifestyle guidelines - during therapy.

Resources

[1] https://www.voedingscentrum.nl/encyclopedie/pioppi-dieet.aspx

[2] More information on the Seven Countries study: https://www.sevencountriesstudy.com

[3] https://www.voedingscentrum.nl/encyclopedie/pioppi-dieet.aspx

[4] F.A.J. Muskiet, M.H.A. Muskiet and R.S. Kuipers, The bankruptcy of the saturated fat hypothesis of cardiovascular disease, Ned Tijdschr Klin Chem Labgeneesk 2012; 37: 192-211
https://www.nvkc.nl/sites/default/files/NTKC/2012-3-p192-211.pdf

[5] On page 143 of the book The Pioppi Diet, it states that the diet follows the guidelines of the World Cancer Research Fund and recommends a maximum of 500 grams of red meat, preferably unprocessed and from grass-fed animals.

[6] From pages 319 through 327 of the book The Pioppi Diet, the (scientific) underpinnings of the Pioppi Diet are listed.