The Pioppi Diet - Written neither for the seasoned professional nor the casual reader this book fails in so many areas.

The Pioppi Diet is chock full-of references – so it is not aimed at the casual reader. For this review I checked just a few of the facts and interpretations – and they’re wrong. So the book cannot be aimed at the seasoned professional. Instead it is aimed at the huge army of those practising in the private sector where expertise is rarely questioned, and/or those who are educated by Dr Google.

In other words the ‘expert wannabes’.

Throughout this review I am concentrating on the content of the book rather than the writer although it is interesting to see the result s of putting ‘Malhotra quack’ into Google.

The book has a foreword written by David Haslam, Chairman of the National Obesity Forum. He says: “There is nothing fanciful about the message or the science upon which the book is based…” The National Obesity Forum has on its site the following advice:

“A main concern is their restriction of whole grains and many fruits and vegetables (which help protect against cancer and heart disease), and unless lean meats and low fat cheeses are chosen, saturated fat intake is high. There is also currently no evidence that low carb diets are either healthy to follow, nor help people control their weight in the long-term” (NOF)

The forum – i.e. Malhotra and Haslam - released a document that is similar to large chunks of the Pioppi Diet book and they say:

“The approach described in the document is nothing new, and the wording is deliberately phrased in respect to Hippocrates, the Father of Medicine who recommended ‘rich foods’ to stay thin, including fatty meats, especially grassfed animals”

And that is correct. The arguments put forward in the book indeed do offer nothing new – however much studies are misinterpreted. (But more of that later)

The introduction goes on to say: “Now you can bring the Mediterranean Diet into your own kitchen…” This is just nonsense as the introduction also says :”This brilliant book  demonstrates the evolution of the concept ‘diet’..Referring to food, lifestyle and culture’. Indeed other reviewers on Amazon make the same point.

Good luck bringing sunshine and stress-free living to your kitchen.

Now we move to the Introduction.

Apparently ‘over 60% of the UK adult population are overweight or obese’ Yes, actually it is 63% according to Public Health England. According to Malhotra in a tweet on 3 March 2015: “Public health minister has agreed that physical inactivity is NOT linked to #obesity. It's all about calories consumed!” With a ridiculous mindset like that I despair as to the use of this book, but I continued reading…

Clearly obesity is a major contributory factor when it comes to (ill)health so I was surprised to see (page 7):

“…like many of the lifestyle elements we identified during our time in Pioppi, it is impossible to isolate any one factor as an elixir of the remarkable health and longevity …”

So it is NOT just calories consumed then. In fact on the NHS.UK site Professor Jebb is quoted as saying:

“Obesity is a consequence of the abundance and convenience of modern life as well as the human body's propensity to store fat,"

In fact obesity has a multiple of causes including "obesogenic environments". These are places, often urban, that encourage unhealthy eating and inactivity. The car, TV, computers, desk jobs, high-calorie food, and clever food marketing have all contributed to encourage inactivity and overeating.

The authors quote Mayor Pisani  where he says that the Greek word ‘diaita’ has been misunderstood and that in fact it means lifestyle and ‘within that we include many things – the landscape, the sea, quality of life, culture, the work and many other things’.

In fact the work of those in Pioppi includes ‘decades of slow, constant, habitual movement (walking) along with intense, strength-maintaining bursts of full-body activity (wood chopping and so on).’

In our modern day parlance that means walking and HIIT.

Now we consider the ‘healthcare manifesto’ (chapter 2).

Almost straight away we come across a horrendous Malhotra error – which is why this book is suitable for wannabes only as they won’t check the facts. Malhotra says: ‘…poor diet now contributes more to disease and death globally than does lack of physical activity, smoking and alcohol combined…’

This claim is then shown in a funky graph on page 18 – the chart is taken from a Daily Telegraph article in 2015. The data is arrived at as follows:

1. Go to the relevant Lancet report (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2812%2961766-8/abstract)
2. Looked at the graph that shows the percentage of disability-adjusted life years attributed to different factors.
3. Add the diet-related factors together and come up with a big number.
4. Simply subtract the 5.4 per cent for alcohol to get the 34.6 per cent seen in the Telegraph graphic.
5. Included is every death from high blood pressure, high body-mass index and high cholesterol under "diet". These factors can be influenced by diet, to be sure, but there are many other causes. It is quite wrong to group them together in this way
6. Moreover, you simply can't add these figures together. One of the counter-intuitive aspects of epidemiology is that it creates attributable fractions for risk factors which, if added together, would suggest that there are many more deaths than there are people dying

In short, that statement is just rubbish, rubbish that has been debunked over 2 years ago. And now it reappears in this ‘new health revolution’ book!

The rest of the chapter blabs on about medical training and includes this astounding statement:

“Only from my own research, and many years after qualifying as a medical doctor, have I concluded that adopting a high-fat Mediterranean diet, quitting smoking and engaging in mindful movement and stress reduction are more powerful than any drug in the prevention of disease…”

He means he didn’t KNOW, as a medical doctor?? With the exception of the high-fat theory which is wrong as I will comment on later, everything else is common sense!!!

We now move onto chapter 3 which is about processed food. Here Professor Lustig is quoted and a list of nutritional properties and markers that distinguish processed food are shown. Most are prefaced by ‘too little’ or ‘too much’ – very clearly defined terms…not. Malhotra also concludes that one glass of red wine a day is fine, no mention of a link to breast cancer.

Chapter 4 is about picking on sugar. This has another of these made up claims:

“In industrialised countries between 5 and 10% of GDP is spent on treating dental disease which is entirely avoidable”  In 2013, total healthcare expenditure was £150.6 billion according to the Office for National Statistics.  In 2017 GDP in the UK was £2618.89bn USD. 7.5% of that is 196bn USD  So apparently the treatment of dental disease dwarfs total healthcare expenditure – even though it is part of total healthcare! (I am assuming total healthcare increased to £196bn) Clearly the assumption is that no pharmaceutical products were prescribed! (They made up 33.8% of household spending on medical goods and services in 2013)

Chapter 5 is entitled ‘Saturated fat does not clog the arteries’. He says: “From what we now understand of the biology around the development of heart disease, combined with robust modern scientific data, saturated fat in your diet does not clog your arteries and it is plain wrong to say that it does.’

One main study quoted to support this is BMJ 2015;351:h3978

What the study actually concludes is: “Saturated fats are not associated with all cause mortality, CVD, CHD, ischemic stroke, or type 2 diabetes, but the evidence is heterogeneous with methodological limitations.”

The study also said: “Replacement of saturated fats with polyunsaturated fat reduced coronary risk by 13%”

If you are quoting ‘current research’ (that is two years old) why not refer to a 2017 study:

LINK HERE

CONCLUSION:

Consistent evidence from numerous and multiple different types of clinical and genetic studies unequivocally establishes that LDL causes ASCVD.

or 2015 study - link here

The findings of this updated review are suggestive of a small but potentially important reduction in cardiovascular risk on reduction of saturated fat intake. Replacing the energy from saturated fat with polyunsaturated fat appears to be a useful strategy,

or the 1997 study:


 BMJ. 1997 Jan 11;314(7074):112-7. that concludes:

 “In typical British diets replacing 60% of saturated fats by other fats and avoiding 60% of dietary cholesterol would reduce blood total cholesterol by about 0.8 mmol/l (that is, by 10-15%), with four fifths of this reduction being in low density lipoprotein cholesterol.”

Oh, it doesn’t fit in with the thrust of the book…

Moving on to chapter 6 which is about cholesterol.

The authors state that cholesterol is not to be feared. This is from a cardiologist who surely is familiar with the VAP test, the role of particles and VLDL and all cause mortality. Maybe that is too much though, for the audience, as such in depth analysis is not available on the NHS.

They also say this about statins: “..if you haven’ suffered a heart attack or haven’t been diagnosed with heart disease, it will not prolong your life by one day”. Then a few lines later: “…it is far more plausible that the benefit from statin drugs in reducing heart attack rates derive from their effects on reducing inflammation…”

Hang on. ‘Benefits’ – surely benefits will prolong your life? Or do statins only reduce heart attacks in those who have already had one? In which case why only after the event and not before?

Interestingly one of the authors is in a facebook group where this very page was discussed. He was privately messaged by the two group admins asking for a comment plus several times by others posting the quotes I have just listed, plus sent tweets asking for comments.

Silence.

Maybe too busy. Maybe unsure. Maybe wrong.

Chapter 7 deals with the root cause of heart disease. In this chapter the authors refer in depth to the Lyon Diet Heart Study. They concluded that ‘the results seen in the Mediterranean diet group were quite extraordinary’

Indeed they were and the Med group, by comparison were the LOW FAT group – though the Pioppi diet authors say the low fat group was the other one. Add to that, that people in BOTH groups took lipid lowering drugs and also that the study was deeply flawed and you have a misinterpreted study that works against the premise of the book – and a flawed study at that!

Insulin resistance is also seen as a big enemy here, and rightly so. But…what impacts on IR? Sugar – depending on how it is consumers and…saturated fat! It is thought the negative effects associated with high intakes of saturated fats from processed and red meat can become toxic, causing inflammation and oxidative stress in human adipose (fat) tissue, leading to impairment of mitochondrial function and insulin signalling, and consequently insulin resistance. (Rachek, LI 2014, ‘Chapter Eight: Free Fatty Acids and Skeletal Muscle Insulin Resistance’, Progress in Molecular Biology and Translational Science, vol. 121, no. Glucose Homeostasis and the Pathogenesis of Diabetes Mellitus, pp. 267-292.

Other chapters deal with how we shouldn’t calorie count and also – shock horror – “in the past four decades there has been very little change in activity levels in the western world” (page 102)

As Public Health England noted in a major report last year, ‘People in the UK today are 24 per cent less active than in 1961’. British Heart Foundation figures show that British adults are walking less (from 255 miles per year in 1976 to 181 miles in 2012) and the proportion of British children who walk to school has dropped from 70 per cent in 1980 to less than 50 per cent today.

At work, we are less physically active than ever. Jobs in agriculture declined from 11 per cent to two per cent of employment in the 20th century while manufacturing jobs declined from 28 to 14 per cent. Less than one in five adults report doing any moderate or vigorous physical activity at work. Outside of work, 53 per cent of us take part in no sports or exercise at all.

In terms of weight loss exercise does four things:

1. burns extra exercise whilst exercising
2. burns extra calories after exercising
3. if putting on muscle then increases metabolic rate
4. suppresses hunger

So, cut down on activity……and to deny that activity levels have fallen - merely deceives the wannabe (expert) reader. This book is stuffed full of recipes. I strongly suspect Malhotra will be bringing out a cookery programme or DVD soon (that would sell better than an exercise DVD)

Part one concluded with a chapter on stress and one on intermittent fasting. The stress chapter could have included more ways to reduce stress as surely everyone – well before Malhorta qualified as a medical doctor – know that stress kills; stress causes heart disease; stress can cause you to put on weight.

A shallow chapter – almost as if the writers had lost interest.

Part two deals with the 21 day plan. We are advised to move and breathe and socialise. All revolutionary ideas …not.

Then we come to the movement protocol. This should have been a key section of the book. After all surely there would be different exercises according to gender, body type, age, health background? Surely yoga would feature? There would be targets and clear drawings, maybe links to free videos?

No.

Just a series of grotty black and white photos way too small. But…what should one do with the exercises? How many repetitions? Build up as you go lalong, starting every day with day one then two etc?

I have no idea.

I asked nearly all the people who had reviewed the book for Amazon and written how brilliant it was and how it changed lives etc et and even though, I assume, they fully understood the book otherwise why give five stars, not one of them could or would answer. Instead  I was followed round by someone telling me to ask the authors – the same authors who avoided questions about statins.

Hopeless.

Some of the exercises (days 5 and 14) should be advised against if you are at a high stroke risk – but again no pre-exercise health questionnaire that you should show to your doctor, is included in the book.

The rest of the book is food lists and recipes. A much better book is just to buy a recipe book showing pictures!

A list of produce to buy is given and readers are urged to buy local and organic where possible. This is more misguided advice as there is no need to buy organic for asparagus, avocado, cabbage, cantaloupe, onion, sweet potato. Buying organic is more expensive so only do so when necessary.

The book concludes with: “…helped make this book come to fruition for the sole purpose of helping millions improve their health for the better” That too is nonsense. Sole purpose? So the paid for lecture tours, the downloadable videos, the paperback and kindle – sole purpose? Nothing to do with money or profile or celebrity status?

The book could have been made available on kindle for free – the distribution costs are zero.

OK that is a review of the book – but what has been left out?

Longevity is greatly affected by pollution. The word does not even appear in the index! Nothing about pollution in the UK and how the government has failed to meet targets. Nothing about climate change either. Yoga is also not in the index – so no helpful poses to relieve stress. Nothing about home-based pollutants.

It has been said that there is no business model for lifestyle changes – but there is. It is producing products that revamp existing research, repeat incorrect results to a growing group of devotees that cling to your coat-tails and seemingly lack the ability to question.

It’s a small market so first mover advantage is much sought after.

I have read several very critical reviews of the Pioppi Diet, factually based and well-resourced. None of then appear on Amazon – could this be because the response a bad review gets? The first negative review was deleted. The second one lead to an argument where the ‘Pioppi-promoter’ sought to identify the real identity of the reviewer and then cast aspersions.

By ye fruits…