Diet secrets of the world's healthiest village

Could a Mediterranean diet be the answer to living a long life? Photo / Getty

Dr Aseem Malhotra was in the middle of his ward round when lunch was brought out by the health assistants. He had just reached the bedside of a man whose life he had saved the night before. The patient, in his 50s, had been brought in as an emergency, needing an angioplasty to unblock an artery to his heart.

Far from simply thanking Malhotra, the man was becoming agitated. On seeing his lunch - a burger and chips - he said: "How do you expect me to get well when you are serving me the same kind of cr-- that brought me here in the first place?"

"He had a good point," says Malhotra. "I used to talk to all the patients about lifestyle changes, such as stopping smoking, they could make to prevent them coming back in. But I hadn't made the connection to nutrition."

At the time, Malhotra, now 39, was working as a cardiology specialist registrar at the renowned Harefield Hospital, Hillingdon, and had been a qualified doctor for 10 years, operating on hundreds of patients with heart disease. "Of course, I had noticed more stress on the system, and that people were coming in with conditions linked to obesity." But it was this conversation that triggered his interest in how he could make a difference through diet.

Malhotra's calling

Seven years later, his curiosity has become something of a calling. Having extensively researched the causes of obesity, Malhotra became a founding member of Action on Sugar, a pressure group run by senior doctors in the UK and is now is now a leading figure in the public health campaign against sugar, calling for next April's "sugar tax" on soft drinks to cover all confectionery products.

"I read all the research I could and concluded that simple lifestyle changes such as consuming less sugar were more powerful than any medication doctors can prescribe."

It takes its name from a small Italian village where the locals not only tend to live longer - the average man has a lifespan of 89; many live to 100 - but do so without contracting the chronic diseases of ageing, such as type-2 diabetes and dementia, that the rest of the world accepts as inevitable.

The doctor's interest in Pioppi was two-fold. The locals' way of life was clearly fascinating: was it just diet which kept the population so well for so long, and could lessons be extrapolated for the wider world?

But Pioppi also has a sort of iconic significance. It was the home from home for American physiologist, Professor Ancel Keys, who first developed the idea of a Mediterranean Diet as being the ideal eating plan, in the 50s. Pioppi is even protected by Unesco as a result.
 
But Keys was also famous as the man who demonised saturated fat, theorising that it was the cause of blocked arteries and, as a result, heart disease - a position Dr Malhotra no longer agreed with.

Documenting their findings

Visiting the village with filmmaker Donal O'Neill to make a documentary called The Big Fat Fix in 2015 he was able to examine the Pioppians more closely.

And possibly the most important lesson Malhotra learnt as he did, was that the word diet as we understand it is a misinterpretation of the Greek word diatia, which means lifestyle. Eating olive oil and fresh fish was just part of the Pioppians' wider picture, he concluded, which included habitual daily movement, lack of stress, good quality sleep, and a sociable, inclusive society.

"Yes, the locals eat pasta - but only in small quantities, and they rarely touch sugar. They only eat dessert on a Sunday, pizza once or twice a month. They take time over lunch. They don't have a gym in Pioppi but they are constantly on the go."

It's a prescription, he believes, that could be life-changing back in the UK if followed. "When we recommend food and lifestyle changes, reducing intake of sugar and refined carbohydrates, patients achieve a fast result, definitely within 21 days. I've seen type-2 diabetes reverse, something we were taught at medical school couldn't happen."

Malhotra practises what he preaches, having completely overhauled the eating habits he developed growing up in Stalybridge, Cheshire. "I was a proper sugar addict: Coco Pops for breakfast, a KitKat and a packet of crisps in break time at school. Luckily I was sporty, but I was always hungry so I snacked all the time. That was normal, wasn't it?"

The diet recommends eating 10 eggs each week. Photo / Getty

Although a talented cricketer, he had been drawn to medicine, cardiology in particular, due in part to the death of his older brother at 13 from heart failure, caused by a virus.

"Amit, who was two years older than me, had Down syndrome and he taught me about compassion. His death was just bad luck, but it had a real impact on me."
 
Both of their parents were GPs; in fact his father later taught Malhotra to cook, meaning he enjoyed a reputation at Edinburgh University where he began medical studies, as "the guy who cooks the best chicken curry". He adds: "But I didn't appreciate how impactful and important food was to health. And we didn't learn anything about it at medical school. I always ate dessert and chocolate."

Dramatic changes

Within weeks of cutting out the vast quantities of sugar, bread and pasta he had been consuming from his diet, he shed a stone in weight from his midriff - a happy "side effect" of a healthy lifestyle which "reduces the chance of heart disease, dementia and cancer, too".
 
"Diet is the number one issue," he adds. "More than physical inactivity, smoking and alcohol, it contributes to more disease and deaths. This should be the message from doctors: that food is medicine. And if we all took up the challenge, the effect on the NHS budget would be transformatory too."

Of course, not everyone will find it easy to transform their entire diet and lifestyle.

"Healthy food needs to be made affordable, for a start. And we know that certain groups find this harder than others. If you work a night shift - as I know - you are more likely to eat sugary processed food. So we need to get rid of vending machines full of chocolate bars and ban junk food in hospitals."

He thinks "bold" chief executives could even end the coffee shop culture in hospitals, which sees staff and patients alike hooked up to endless lattes and muffins.

There are also those who overeat for emotional reasons.

"Comfort eating ties into stress which is itself a massive risk factor for many diseases. So we need to deal with that, whether that's by offering mediation, yoga or Pilates classes. Or encouraging more social interaction and friendship off line."

Lastly, he points out, "There is no such thing as a healthy weight, but a healthy person. That is what we should all be aiming for. Living like a Pioppian would mean a reduction in the 20 million deaths worldwide caused by cardiovascular disease. Plus obesity reversed and levels of type 2 diabetes declining. That's my ultimate dream."

Eight tips to get started with the Pioppi diet

1. Don't fear fat; sugar and refined carbs are the enemy

2. Keep moving - exercise for health not weight loss (and walking is best)

3. Extra virgin olive oil is medicine, as is a small handful of nuts - eat both, every day

4. Get seven hours of sleep a night

5. Stop counting calories - not all are created equal

6. Eat 10 eggs a week - they're satiating and full of protein

7. Have two portions of veg in at least two meals a day

8. Fast once a week for 24 hours - have dinner, then don't have breakfast or lunch the next day