Mediterranean diet: It’s why Italians are healthier than Americans and why I’m glad I left the United States

The Mediterranean diet is one reason Italy is ranked the second healthiest country in the world.
The Mediterranean diet is one reason Italy is ranked the second healthiest country in the world. Photo by Marina Pascucci

I had my annual checkup Wednesday. Besides the all-day exams costing only €452 as compared to nearly $3,000 for the same tests in the larcenous U.S., the other good news is I received a clean bill of health. I’m lucky. Deadly diseases often pick victims at random. Good genes are inherited, not earned. But there’s another reason I’m 67 and in no fear of “checking out” soon.

I live in Italy. 

That line makes Americans smirk, like when I say my favorite sport now is soccer. The No. 1 question I get is how are Italians so fit in the land of pasta and pizza? The American view of the Italian diet is what Italian food is in the U.S. Sorry. Domino’s pizza lasted seven years here and gave up. A running joke among Italians who visit the U.S. is that Olive Garden’s breadsticks could grease their Fiat.

For the last nine years since retiring to Rome, I’ve adopted the Mediterranean diet. It wasn’t by choice. It’s how you eat in Italy, particularly in the South. It’s fruits, vegetables, white meat, fish, whole-grain pasta and, above all, olive oil. Yes, we eat pasta here. But it’s usually for lunch when it’s easily digestible. It’s with one or two ingredients. The pasta is homemade. The sauce is fresh tomatoes. The pecorino cheese is all natural.

Me (right) eating pasta carbonara with my friend, Alessandro Castellani, at Flavio al Velavevodetto.

Yes, we eat pizza here. But it’s fresh ingredients and mostly vegetable toppings such as mushrooms, carciofi (artichokes), melanzane (artichokes), radicchio (radishes), tomatoes, bell peppers and onions among others. Meats make up a small slice of a pizza menu and never more than one. Crusts in Rome are thinner. There is hardly any grease. An empty pizza tray wouldn’t stain a doily. Pizza in Italy is almost health food.

Domino’s, the No. 1 pizza chain in the U.S. with a revenue last year of $4.53 billion,  has more ingredients than a nuclear submarine. And it’s almost as heavy.

The grease-free pizza plate at 48 Ore pizzeria.

Mediterranean diet by the numbers

According to the Bloomberg Global Health Index, in 2019, the last year the survey was taken, Italy was the second healthiest country in the world with a score of 91.59 behind Spain after years as No. 1. The list:

  1. Spain 92.75
  2. Italy 91.59
  3. Iceland 91.44
  4. Japan 91.38
  5. Switzerland 90.13
  6. Sweden 90.24
  7. Australia 89.29
  8. Singapore 89.29
  9. Norway 89.09
  10. Israel 88.15

The U.S. was 35th at 75.0.

One reason is the U.S. obesity rate is bad and getting worse. According to the Harvard School of Public Health, 69 percent of Americans are overweight with 36 percent classified as obese (defined as a body mass index of over 30).

These are the 10 most obese countries by percentage of population: 

  1. Nauru 61 percent
  2. Palau 55.3
  3. Marshall Islands 52.9
  4. Tuvalu 51.6
  5. Tonga 48.2
  6. Samoa 47.3
  7. Kimbati 46.0
  8. Micronesia 45.8
  9. Kuwait 37.9
  10. U.S. 36.2

Eight of the nine countries more obese than the U.S. are Pacific islands where the diet, due to the countries’ isolation, is primarily imported foods high in salt and fat for longer shelf life.  What percent of Italians are obese?

Twelve percent

Consequently, I will live longer in Italy than if I stayed in the U.S. You can look it up. Italy’s average life expectancy is 84.2 years, sixth highest in the world, according to the World Population Review. In the U.S. it’s 79.74 and 47th. Interestingly, the CDC reports the U.S.’  average dropped this year to 76.4, which would place it 80th, just behind Malaysia and Sri Lanka. It’s the lowest in two decades.

The World Population review list (does not include Monaco, Liechtenstein and Vatican City which would all be listed.):

  1. Hong Kong 85.83
  2. Macao 85.51
  3. Japan 84.95
  4. Switzerland 84.38
  5. Singapore 84.27
  6. Italy 84.20
  7. South Korea 84.14
  8. Spain 84.05
  9. Malta 83.85
  10. Australia 83.73

Classic Roman dishes such as cacio e pepe (top) and puttanesca are simple with natural ingredients.

Problem in U.S.

I don’t need stat charts to tell the difference in countries. When I lived in the U.S., I traveled all over the country as a sportswriter. In many places you needed to spread mayonnaise on the inside of doorways to squeeze people inside a room. When I see an obese person in Rome, I sidle up to them. The vast majority of times I hear American English. 

Yet all over the U.S., in the early morning and 5-7 p.m. time slots, fitness centers are packed. Jogging paths are crowded. Health food stores have long lines. But for every American weighing their food and logging their mile splits, two others do nothing. They have Domino’s on speed dial. They drive to the bathroom. 

I had an obese roommate my senior year in college. We lived in an apartment complex spread over three levels. If he wanted to see a friend on the next level, he’d drive up the hill. The hill was about 30 feet.

Italians walk nearly everywhere. Many, such as myself, don’t have cars. Just walking to and from public transportation and getting around one of the world’s most walkable cities, I walk nearly three miles a day without “going out for a walk.” An Italian tradition is the passeggiata, a stroll they take before or after a meal.

Italy has a wine culture that still dominates its beer culture. Photo by Marina Pascucci

Wine vs. beer

Another huge difference between Italians and Americans is alcohol. Italy has a wine culture, not much of a beer culture. Italians annually drink 35 liters of beer per capita. Americans drink 104. (Burp!) In nine years in Rome I have yet to see a drunk Italian. In the U.S. I had friends who drank a beer to help them decide if they wanted a beer or not.

People have accused me of being a sizeist. Maybe I am. Excuse me if it’s bothersome to read that the U.S. spends an average between $147 billion-$210 billion every year on obesity-related issues such as diabetes and cardiovascular diseases. 

The nutritionist

When I re-upped my gym membership at Anytime Fitness in May, I met with its nutritionist. Cinzia Di Tommaso has worked as a chef, pastry chef and as a diet consultant before becoming a nutritionist. (“Before she was one to get people fat. Now she’s one to get people thin,” said her fiance, Enrico Beltrotti, the gym manager and martial arts instructor.) She gave me an extensive diet plan with emphasis on fish three times a week (agreed), a cutback on my red meat (my favorite pizza is gorgonzola and sausage) and no more than two alcoholic drinks per week. (I promised no more than two before breakfast.)

Cinzia Di Tomasso. Photo by Rachele Faiola

I asked her about the Mediterranean diet which started in the early 1960s in Southern Italy, Southern Spain and Crete. It was based on scientific studies of the benefits of unprocessed foods.

“The Mediterranean diet is based on 60 percent vegetables,” Cinzia told me. “And good fat, like olive oil, olives, seeds. Actually, we use a lot of fresh food because it’s cheaper in respect to meat and fish.”

Italians have a phrase called chilometro zero. That means fresh foods grown and produced close to the place of purchase. Public markets are scattered all over Italy selling produce from surrounding farms. My Mercato San Giovanni di Dio, which began in 1960, is four tram stops up the hill from me. It’s a gritty, open-air, rough-and-tumble market that fills nearly an entire parking lot. It’s where I buy my fruits and vegetables, fish caught that day and bread made that morning.

When I lived in Denver, we had a farmers market but it came only on Sunday and charged about $2.50 for a tomato. We called Whole Foods, the local health food grocery store, Whole Paycheck.

Most Americans also cook in butter and Italians cook in olive oil. One tablespoon of butter contains 7.3 grams of saturated fat compared to 1.8 in extra virgin olive oil. 

My mom was worse. She cooked with Crisco, a vile American cooking staple that was basically a big tub of white lard, so heavy in chemicals it was originally used to make candles. Mom would spread it on every cooking pan so food wouldn’t stick while leading us all down a path of clogged arteries.  

In Rome, I only use butter the three or four times a year I make American pancakes. I use olive oil on such regular dishes as salads, pasta, grilled vegetables and bruschetta. 

“It’s a natural antioxidant,” Cinzia said. “The chemical composition is really better. Olive oil is a liquid instead of the lard or butter which is solid. This kind of fat becomes solid in our bodies. This is the problem.”

Andy Luotto. Photo by Alisa D’Angeli

The chef/restaurateur

Andy Luotto is an American-Italian from Brooklyn who has owned and worked in restaurants in Italy for years. He became famous in Italy with a popular TV cooking show. He wrote four books about Italian cooking. He’s the driving force behind Riva Portese, a new restaurant that will open down the hill from me in September.

No one in Rome is better to address the difference between American and Italian diets. He agrees with me. A major problem is American portions. Pasta dishes in the U.S. look like replicas of Mt. Vesuvius.

“You don’t have to eat that much,” he told me. “Portions in America are ridiculous. They’re huge. The sandwiches … There’s a pastrami palace in America, in New York, called Katz’s. The thing is written on the menu that if you can finish a whole sandwich, they’ll give you another one for free. They print that out. This is how you can eat and get sick.”

Andy emphasizes eating produce in season. In my kitchen I have a produce wheel that lists what fruits and vegetables are freshest that month.

“Basically all Italians follow the season,” he said. “The ‘Big Light’ tells you when things are ready to eat. The Mediterranean diet is very, very simple. When you get right down to it, just heat stuff up. Pick it when it’s in season. Add a drop of olive oil and a little garlic. The best dish in the world is spaghetti with tomatoes.

Most Italian pizzas don’t have meat such as this one at La Gatta Mangiona.

“It’s a matter of common sense. Common sense is natural in Italy. In the U.S., you can buy anything any time of year. That’s not good. There’s got to be a reason for the seasons. Also for a cook, it’s kind of fun to say, ‘Sorry, (at this time) we don’t have any broccolini rapa.’”

I understand the sensitivity people have over their bodies. I’ve never body shamed anyone to their face. I know how people feel. I was body shamed as a skinny kid trying to play sports. But I did something about it. I changed my diet. I joined gyms. I moved to Italy. I’m a fairly proportioned 6-foot-2 and 205 pounds. (For 40 years I was 6-3 but Wednesday’s checkup revealed I shrunk an inch. I was reminded I’m 67. “E’ normale,” my doctor told me.)

But I will body shame countries. Americans are embarrassing themselves on the world stage. Not all their fitness video selfies on Instagram can save them. Italy has the best food in the world and it’s not just because its flavors make me swoon like Meg Ryan in Harry Met Sally. It’s because it’s less fried, in smaller proportions and healthier through and through.

It’s something I’m just going to have to live with.