Imagine being admitted to a hospital with a heart attack and a doctor asking how many times a week you eat pizza. This was the actual question that was asked of 507 heart attack victims and 478 others who had been admitted to a hospital in Milan, Italy, between 1995 and 1999. Why? To find out if most Italian foods had any role to play in heart disease. We’ve all heard about the benefits of the highly touted Mediterranean diet, and Italian researchers decided to find out if pizza specifically played a role in protection against cardiovascular disease.
After admission to the hospital, the patients were interviewed about their lifestyle habits and their diets. They filled out a 78-item food frequency questionnaire on the basis of which they were divided into non-pizza eaters, occasional pizza eaters (one to three portions a month) and regular pizza eaters (more than one portion per week). Heart attack victims reported they had exercised less than controls, smoked more often, consumed more coffee and drank less alcohol. No surprise here. They also had more of a history of high blood pressure, consumed more calories, and ate fewer fruits and vegetables. Still no surprise. But the surprise came when pizza eating was considered. Regular pizza eaters were 40 percent less likely to suffer a heart attack than those who never ate pizza! Why this should be so is somewhat of a mystery. Perhaps pizza eating is just an indicator of following a Mediterranean diet, which tends to be lower in fat than the North American diet.
 We have to remember that we are talking about pizza as served in Italy, not the American version. No double cheese, no cheese-filled dough, no piles of pepperoni or globs of trans fat—laden shortening. The dough is thin, the pizza is dressed with olive oil and cheese, and there is plenty of fresh tomato sauce. The answer to this pizza mystery may lie not in what the people are eating, but rather in what they are ²Ô´Ç³ÙÌýeating. Perhaps the pizza is displacing high-fat hamburgers and fries from the diet. Let’s note that a portion of pizza in the Italian study was defined as 200 grams and even the so-called regular eaters averaged only 500 grams (just over a pound) of pizza per week. Indeed, pizza may be displacing higher-calorie foods from the diet. Anyone who thinks that pizza can prevent heart attacks is looking at a pie in the sky.
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