The Pioppi Diet

Malhotra published an article in The BMJ, Saturated Fat is not the Major Issue. He starts his article by saying: ¹

He gave a citation for that statement to the paper, Trans-fatty acids and nonlipid risk factors, which has a completely different conclusion. ²

Popular commentators state that inflammation is the cause of heart disease whilst neglecting to explain what causes the inflammation in the first place.

LDL particles, which contain cholesterol, enter the space inside the lining of the arteries. The cholesterol becomes oxidised. White blood cells recognise this as a foreign particle and engulfs the intruder and plaques develop inside the artery wall. Plaques consist of dead white blood cells (macrophages), fats, cholesterol, and smooth muscle tissue. The plaques intrude into the arteries. Thrombosis (blood clot inside a blood vessel) at the site of a ruptured plaque precipitates most heart attacks.

Malhotra quotes a newspaper report for this information. The article quotes Dr. Gregg Fonarow from the UCLA, who states, ³

Having “normal” cholesterol levels when it is normal to die from a heart attack is not a healthy choice.

Malhotra completely misrepresents the newspaper article’s message, which is the cholesterol guidelines are too high.

William Roberts is a leading cardiovascular pathologist. He is the current editor (at 2016) of the American Journal of Cardiology—a position he has held since 1982. Dr Roberts has also suggested cholesterol goals should be less than 150 mg/dL (3.9 mmol/L) for total cholesterol and less than 60 mg/dL (1.5 mmol/L) for LDL cholesterol. He also contends that the HDL-cholesterol is largely irrelevant and that there is only one risk factor for heart disease—that is, “It’s the cholesterol, stupid”. ⁴

Trichopoulou and colleagues conclude that the major components of the traditional Mediterranean diet are: ⁵ ~ ⁶

Malhotra aversion to wheat results in him ignoring the role of bread and pasta in the Mediterranean Diet of Pioppi.

The popular view that wheat and bread is a major health issue is misplaced. Celiac, wheat allergies and non-celiac gluten sensitivity are important issues but their prevalence is overstated. A review, published in The Journal of Nutrition, of 45 prospective cohort studies and 21 randomized-controlled trials between 1966 and February 2012 found that an increase in the intake of whole grain foods is associated with lower risk of type 2 diabetes, cardiovascular disease, and weight gain. ⁷

Eggs are also problematic. David Jenkins, the Toronto-based researcher of glycaemic index fame, was a co-author of a paper, Egg yolk consumption and carotid plaque that concluded, ⁸

Given that approximately 30% of Australians and Americans die of heart disease, that would place the majority of people at risk.

Jenkins is now advocating a whole-food, plant-based diet for optimal health.

The Physicians’ Health Study

The Physicians’ Health Study commenced in 1981. As well as examining the role of aspirin and a beta-carotene supplement, on heart disease and cancer, it also examined the role of egg consumption on health. The result from a 20-year follow-up showed a significant correlation between egg consumption and all-cause mortality. A key finding is that physicians consuming 7 or more eggs per week had a 31% increase in all-cause mortality compared with those consuming less than 1 egg per week. For diabetic physicians, the association was much higher with the increase in mortality slightly more than doubled. ⁹

A British study reported a 2.7 times greater risk of cardiac deaths for those consuming 6 or more eggs per week. ¹⁰

A British study followed 10,802 health-conscious men and women in the UK with an average follow-up period of 13.3 years. This study reported a 2.7 times increase in risk of death from heart disease with an egg consumption greater than 5 eggs per week compared with those who ate eggs less than once a week. ¹¹

Malhotra is a keen high-fat, low-carbohydrate diet advocate and is desperately trying (unsuccessfully) to combine a high-fat, low-carbohydrate diet into a distorted view of the Mediterranean diet.

Related articles

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The Big Fat Surprise
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TIME Magazine Article – Eat Butter – Part 2
Heart of the Matter – ABC Catalyst

Last updated on Friday 10 April 2026 at 15:02 by administrators

1. Malhotra, A. (2013) Saturated fat is not the major issue. BMJ. 347 (oct22 1), f6340–f6340.
2. Wallace, S. K. & Mozaffarian, D. (2009) Trans-fatty acids and nonlipid risk factors. Current Atherosclerosis Reports. 11 (6), 423.
3. Champeau, R. (2009) Most heart attack patients’ cholesterol levels did not indicate cardiac risk | UCLA (Accessed 3 October 2017)
4. Roberts, W. C. (2010) It’s the cholesterol, stupid! American Journal of Cardiology. 106 (9), 57–73.
5. Trichopoulou, A. & Vasilopoulou, E. (2000) Mediterranean diet and longevity. British Journal of Nutrition. 84 (6), 205–209.
6. Trichopoulou, A. et al. (2009) Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. British Medical Journal. 338 (1), b2337.
7. Qing Ye, E. et al. (2012) Greater Whole-Grain Intake is Associated with Lower Risk of Type 2 Diabetes, Cardiovascular Disease, and Weight Gain. The Journal of Nutrition. 142 (7), 1304– 1313.
8. Spence, J. D. et al. (2012) Egg yolk consumption and carotid plaque. Atherosclerosis. 224 (2), 469–473.
9. Djoussé, L. & Gaziano, J. M. (2008) Egg consumption in relation to cardiovascular disease and mortality: the Physicians’ Health Study. American Journal of Clinical Nutrition. 87 (4), 964–969.
10. Mann, J. I. et al. (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart. 78 (5), 450–455.
11. Mann, J. I. et al. (1997) Dietary determinants of ischaemic heart disease in health conscious individuals. Heart. 78 (5), 450–455.