Today’s PrimalMed Prescription… Pizza, Pizza, Pizza…on the Amalfi Coast!
7 days in a row…but ONLY in Italy!
Fresh off our trip to the Amalfi Coast, the PrimalMed team sampled Classic pizza…Napoletana style!
Ellen Metzger MS, RD, aka The PrimalRD is BACK for a deep dive on pizza…. Is it different than the Pizza we eat here? Maybe. Is it PrimalMed approved? We’ll see. As Ellen will explain below, the devil is in the details!
On our most recent trip to Italy, no one can deny the coastal beauty of the sparkling waters of the sea to the captivating, picturesque views of towns perched high on the cliffs. The Coast is adorned with lush Mediterranean vegetation, including lemon groves, olive trees, and vineyards.
With its simplicity and fresh ingredients, food plays a significant role in Italian culture and is often considered the cornerstone of the Italian lifestyle. Restaurants adapt to seasonal ingredients throughout the year, most locally grown.
It was in Italy, that the Slow Food Movement https://www.slowfood.com was founded, its ethos being environmentally responsible, naturally produced food.
As we explored and savored authentic Italian eateries along the coast, I understood what my clients often note, they ‘feel better’ when eating in Italy.
What is it about the food eaten in Italy?
Especially their most popular food…Pizza!
It is the AUTHENTIC Italian Pizza, made with their wheat, that is of much interest to me.
Over the years, we’ve seen an increase in gluten sensitivity noticeably in the form of gut issues, but also skin conditions, headaches, brain fog, anxiety, etc. My interest in gluten (a protein in wheat) stems from my understanding that there is usually a root cause, an underlying mechanism contributing much to our chronic disease. A gluten sensitivity, however, is not to be confused with Celiac disease, a genetically pre-disposed autoimmune disorder where gluten ingestion results in an immune response, damaging the walls of the small intestine.
This wheat we speak of, containing gluten, is one of the most commonly grown and consumed cereal grains worldwide. Gluten is found naturally, not only in wheat, but also in barley, rye, and triticale (a hybrid of wheat and rye). Other species of wheat that also contain gluten include durum, spelt, and farro. While oats are naturally gluten free, they may come in contact with gluten-containing grains such as wheat, rye and barley at the farm, in storage or during transportation.
But this gluten protein in wheat, may not be the problem per se, as to why there is an increase in gluten sensitivity. Perhaps, one of the issues, may be what has been done to this wheat…
Ok, sidetracked a bit on Gluten…we’ll come back to that!
So, what is it about Italian Pizza that clients report feeling better when eating in Italy?
Fresh and locally sourced ingredients, such as tomatoes, are ripe, pureed, and unflavored. No additives or colorings are added, allowing the natural tomato flavor and appearance to shine. The Italian climate, with its warm summers and fertile soil, provides favorable conditions for tomato cultivation.
Buffalo mozzarella, made from domestic water buffaloes, has a higher water content compared to cow milk mozzarella, which tends to retain its shape when heated, providing a softer, creamier texture – and more easily digestible, as many do find.
American pizzerias may thicken and flavor sauces, usually slow cooked beforehand. Canned tomatoes, if used, may have excess water not needed. Corn starch may then be added to thicken, prolonging cooking time and perhaps reducing the nutritional value of tomatoes.
American pizza tends to use partially skimmed Cow milk Mozzarella, also incorporating several cheese types like provolone. The lower water content contributes to that classic "pull" when you bite into a slice of pizza. Digestibility varies, again with some individuals finding buffalo milk more easily digestible. And don’t forget the toppings… from extra cheese, to mushrooms, to meat and chicken, to figs…and even pineapples.
Light, airy dough of Italian Pizza is simply unbleached flour, water, salt and yeast. But it is the wheat, the type of wheat, that is the defining factor of any bag of flour.
The majority of European wheat grown is soft wheat (or durum wheat), which is lower in protein (due to the removal of bran and germ during production) and thus lower in gluten.
In Italy, 00 flour is the gold standard for Neapolitan Pizza, the finest grind size - as evidenced by the “00” classification, creating a light and airy crust, with a slightly chewy center. (00 classification is the finest, 2 is the most coarse). Neapolitan-style dough requires at least 24 hours to ferment to allow the leavening of the flour in the dough.
American pizza dough may be made with bleached flour, sugar, shortening, yeast, and salt.
The majority of American wheat grown is hard red wheat, higher in protein and thus gluten. The grind size chosen affects the fineness or coarseness of the flour. Bread flour is typically made from red wheat, giving it a higher protein amount, able to absorb more water than 00 flour. This generates a strong, chewy bread-like base, with the higher gluten giving bread that spongy interior.
All-purpose flour is made from a combination of hard and soft wheat and tends to be higher in protein and gluten.
Cooking Techniques often involve simple preparations, favoring simplicity in its toppings, focusing on high quality ingredients, and preserving the natural flavors and nutritional value. It is rare to find an Italian pizza with more than 3 toppings, as the belief is that different pizza toppings cause disharmony in your mouth during chewing. Few chosen toppings should create a natural harmony when eating. Traditional Margherita pizza features just three basic toppings: tomatoes, mozzarella cheese, and fresh basil leaves; Marinara pizza (tomato sauce, garlic, and oregano) and Bianca pizza (olive oil, salt, and rosemary).
The Eating experience of traditional Italian food is in the smaller portions, eaten slowly and mindfully enjoying the flavors and ambiance – this can actually enhance better digestion and perhaps influence our perception of how food affects us. Individual pizzas are the norm, where a knife and fork are used to portion out and savor each bite.
In 1889, Chef Raffaele Esposito of Naples, Italy, was called to make a Pizza in honor of King Umberto and Queen Margherita’s visit to Naples. He made the Pizza with basil (green), cheese (white) and tomato sauce (red) to represent the three colors of the Italian flag in order to show respect to his country. He named it the Margherita Pizza. Leon Goedhart/Getty Images
So, the Italian dough, the fresh sauce, the seasonal ingredients and toppings all add to clients feeling better – HOWEVER, maybe they feel better simply because Italy has strict laws regarding chemicals in their food.
THIS is where I take a deep dive…and circle back to our discussion on wheat.
Glyphosate, the active chemical ingredient used in Roundup, is the most common herbicide worldwide, used on crops of wheat, corn, soy and others…BUT its use is not as widespread in Europe, which bans or heavily restricts its use. Glyphosate is also used for desiccation, where American farmers may prepare wheat for harvest, by spraying wheat with glyphosate in order to “dry it out.” This is quicker, cheaper, travels well and stores better than fresh cut wheat. However, this significantly increases glyphosate residues in foods made with wheat.
Glyphosate is not allowed to be sprayed on organic wheat according to USDA organic standards.
Studies have shown that glyphosate can disrupt the bacteria in our gut. We need ‘good bacteria’ to modulate our immune system, form a barrier against pathogens, manufacture nutrients and neurotransmitters, function in our gut brain axis and other properties we have yet to discover. https://tinyurl.com/46cb2kyd
Just google ‘Does Glyphosate affect human gut microbiota?’ You’ll see many references on how damage to the gut biome is linked to a variety of diseases.
In studying Gut issues, the contribution of herbicides and its correlation to celiac disease (an autoimmune reaction to gluten that damages the intestines and causes nutrient malabsorption), is just a clinical hypothesis. Although not a direct causation in any way, it is an interesting argument, nevertheless. Given the heavy use of Round-Up on conventionally raised wheat crops, the high intake of wheat in the average American diet, and how the body mistakenly reacts to gluten as if it were a poison (autoimmune = attacking one’s tissues) it seems to be a perfect storm for creating intestinal permeability, possibly celiac disease and other autoimmune issues. https://tinyurl.com/2nfv6dup.
Hospital discharge diagnosis (any) of celiac disease ICD-9 579 and glyphosate applications to wheat (R=0.9759, p≤1.862e-06). Sources: USDA:NASS; CDC. (Figure courtesy of Nancy Swanson).
In addition, could the common use of glyphosate (and other conventional chemicals) on a wide variety of foods eaten - also be contributing to the explosive increase in food allergies/sensitivities, especially in children? https://tinyurl.com/yc2ww8xr.
Can we identify digestive issues by looking at glyphosate being a possible root cause? Just note that rarely does just one specific issue cause the development of gluten sensitivity. Also note that not every farmer uses glyphosate.
NOW let’s get back to Pizza.
The quality and freshness of Italian ingredients is the cornerstone of Italian Pizza. It is quite rare to find the same standard traditional Pizzeria in America due to the huge influence of commercialization. Most American pizza chains of today promote a thicker crust or Deep-dish pizza - extra cheese, larger portions and an array of toppings.
10 years ago, my brother Ari Shapiro, opened Falora, an Italian restaurant in Tucson, AZ. His vision was partly inspired by his trips to Italy where a sense of community was paired with simple, fresh food.
Ingredients were imported from Italy and others farmed locally….San Marzano tomatoes grown on volcanic plains near Mount Vesuvius; Mozzarella di Bufala from Italian water buffalo; and Caputo 00 flour from Naples, finely ground, with lower gluten content. The natural yeast imparts unique flavors to the dough and contributes to its slow fermentation. The slow fermentation process allows the dough to undergo more thorough enzymatic activity, breaking down complex carbohydrates and proteins, which can improve digestibility.
A simple 13-inch diameter Falora pie, eaten slowly, savors the authentic flavors of Italy while the atmosphere evokes an old-world pizzeria. The wood-fired 2.5 ton oven, barely fitting though the domed window, was exported from Stefano Ferrara, a third-generation hand builder of ovens in Napoli, Italy. It is this centerpiece, cranked up to 800 degrees, that makes a simple and authentic Napoli pizza possible.
How we feel, the symptoms we experience, the gut issues that arise - may very well be related to ingredients in our food, but more so, what has been done to these ingredients in our food. As written in a previous blog, I noted many European countries have strict laws for food hygiene and safety, including banned ingredients allowed in the U.S.
So much of our food – and not only Pizza – has created a country of metabolically unhealthy citizens, many with digestive issues, chronic disease and low energy. Chemically treated, processed, convenience products, often high in additives, preservatives and unhealthy fats, cannot be compared to the fresh outdoor markets or the restaurants providing seasonally prepared foods.
Is the pizza in Italy different? Yes.
Is it PrimalMed approved? It depends. The quality and quantity of what we eat does matter.
If you want real authentic Italian pizza, perhaps take a trip to Tucson.
Better yet, plan that trip to Italy…
Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.
Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.
The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.
What an amazing article, interesting and informative. Thanks for taking those deep dives keeping us aware of what is healthy and not healthy and backing it up with research. For me, Italy is a far away dream, but Tucson is where I live. You are absolutely right about Falora. It’s no wonder everything there is so delicious. Happy to hear that Italy was such a lovely experience. Do keep on writing your wonderful articles.
wow, what a well written deep dive into non-deep-dish za! grazie for the falora wrods, all true, ari & kerry