What We Can Learn About Good Health From the Sicilian Diet

When we look at longevity, diet, and the connection between lifestyle and disease, we can turn to centuries of habits to learn how to live long and well.

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iMarzi/ Shutterstock
iMarzi/ Shutterstock

THIS IS NOT A DIET BOOK. It is a guide to a lifestyle inspired by the wisdom of our ancestors and the flavor of their food. We are going to take you to a journey to Sicily, walk through her history, experience her passion and taste the simple and nutritious recipes created by her rich volcanic soil, her burning sun and her deep, clear sea waters. We will be sharing with you the scientific data that support the evidence of that wisdom. 

Sicily, “umbilicus mundi”, (belly button of the world) has been forever the protagonist of the history of humanity and a fierce protectionist of recipes that have been transmitted orally and in writing for many generations and over thousands of years. 

My wife Sandra and I are physicians who believe that good nutrition is fundamental to improve the healthspan and the lifespan of our patients. Our daughter is a nutritionist, our son is a permaculture farmer, and his wife is a physician who also treats her patients with nutrition and lifestyle change. 

Sicily is the home of many centenarians and supercentenarians. Centenarians are people that live to be over 100 years old, and supercentenarians are those that live beyond 110 years of age. It is our deepest conviction, after caring for many patients and having studied the lifestyle and diets of Sicilian centenarians, that there is a way of eating and living that promotes health that is truly a better and more enjoyable way of experiencing life. 

Our mission in writing this book is to present to you the Sicilian lifestyle that has been successfully practiced for three thousand years and has helped Sicilians live long and well. The Sicilian way of eating and living can be easily adopted into anyone’s daily routine. 

As nutritionally focused physicians we have written this book to present a way of eating that we believe is the best version of the Mediterranean diet. This is The Sicilian Secret we want to share with you. 

The first rule of good nutrition is that the food needs to be delicious. The Sicilian Mediterranean diet is unique because it has been influenced by the many cultures that have invaded and settled in Sicily. These populations of conquerors added their food heritage to the Sicilian cuisine. The Sicilians artfully integrated it into theirs and the result is a diet that is both delicious, interesting and health promoting. This is the original fusion cuisine.

Sandra was born and raised in Sicily and we have been traveling there for over 30 years, observing, and studying the lifestyle and diet of the local population. We have met many wonderful people who live simple healthy lives. Sicily has been both cursed and blessed by its poverty and isolation from mainland Italy. Many Italian immigrants to America have come from Sicily because of this extreme poverty. However, because of this isolation, Sicily was passed over to a certain degree by modernity and was able to maintain its traditional ways of life and food culture to a greater degree than other areas of Europe that quickly changed after the industrial revolution. 

Many Americans have never learned the basics of healthy eating. The United States is in the middle of a national eating disorder crisis. It is estimated that our poor eating habits cause 700,000 deaths each year because of obesity, heart disease, strokes, diabetes, decreased immunity, and dementia. Americans eat a dismal quantity of whole foods like fruits and vegetables and an excessive amount of processed food that contains added salt, sugar, and saturated fats. In addition, our consumption of red meats and sugary drinks are excessive. The obesity rate in U.S. children is rising so fast that it is estimated that 60% of today’s children will be obese by age 35 if this trend is not reversed. Since obesity is exceedingly difficult to turn around at any age, adults need to change and adopt healthy lifestyles for themselves and their children. 

Let us become the best ancestors we can be.

A Brief History of Sicilian Food

SICILY IS AN ISLAND IN the middle of the Mediterranean Sea and because of its strategic location it was the center of the most important naval routes. As an island, it offered natural vantage points to view and defend from enemies approaching by water. At 10,000 square miles, it is the largest island in the Mediterranean and is blessed with harbors and hills, rich volcanic soil, plentiful fresh water, a temperate climate, and long growing seasons. Different cultures and populations have conquered and inhabited the island bringing with them their traditions and leaving behind their culinary histories. Sicily has belonged to many civilizations, but it has never been part of any. 

Unlike what has happened in many other cultures, in Sicily the new never displaced the old and the new culinary recipes found strengths in the old ones. In the Sicilian culture and history traditions and innovations live in harmony and the past and present walk hand in hand.

 The mild climate, the fertile terrain and the abundance of fish have helped to give birth to a cuisine that has successfully integrated multiple cultures. Nature and history have contributed to the heterogeneity and the uniqueness of the Sicilian diet.

 Humans arrived in Sicily at the same time that Homo Sapiens appeared as a species, 5 or 6 million years ago through the Africa-Asia-Europe-Sicily migration. The Sikanians inhabited the Island 3000 years ago possibly reaching Sicily from Spain or Ligury. The Siculi arrived in Sicily in 1400 BC from the middle East and the Balkans. The name Siculi means Sickle, they were a population of farmers who later learned the art of navigation to become fishermen in addition to farmers.  

Following the Siculi, the Greeks arrived. From then on, a colorful parade followed. Phoenicians (from modern day Syria), Carthaginians from northern Africa, Persians, Romans, Turks, Tunisians, Normans, Swabians (from what is now southwest Germany), French, Spaniards, and the Vikings. They came and conquered leaving behind traces of their languages, architecture, art, and cuisine. They also left behind their genes. 

The Sikanians built lava rock mills for their grains and cooked their meats on the grill. We believe that the first dessert that humans consumed might have been made in Sicily with honey and fresh ricotta cheese. A famous dessert the “cuccia” is still made today in some parts of Sicily and is remarkably similar to that very first Sicilian dessert. 

In Homer’s Odyssey we find the beginning traces of the future importance of Sicilian gastronomic history and through these writings the export of the Sicilian cuisine around the world began. Ulysses discovered pecorino cheese in Polyphemus’s cave! Barley was most likely the first cereal cultivated in Sicily. It was toasted and then minced to make a flour that when boiled in water transformed into in a very nutritious food. With the discovery of grains, nutrition improved, and it was necessary to eat less to feel satiated. Without the Greeks or the Arabs, the Sicilian landscape would probably be quite different today. The oranges, lemon trees, grapevines and olive trees that today enthusiastically represent Sicily, were introduced by the populations that conquered and inhabited the island.

 The Phoenicians, the Carthaginians and the Greeks have left their traces in the way the modern-day Sicilians make their breads and in the way they cure their olives or salt their ricotta. 

The Phoenicians promoted the culture of olives, they taught Sicilians how to extract salt from the sea, how to care for livestock, how to keep wine in ceramic containers, the art of apiculture and the fish industry. Their meals were rich in grains and legumes. They ate vegetables raw or cooked, meat was eaten only occasionally, and they especially enjoyed rabbit with its lean meat. 

Sicilian cuisine was loved by the ancient Greeks. A famous ancient Greek man, named Miteco, from Syracuse, the largest Greek colony in the world, which was located on the east coast of Sicily, taught the Greeks the finer points of Sicilian cooking, which he felt to be the best in the world. Sicilian cuisine was amazingly simple then and consisted of fish, meats (rabbit, goat, sheep) flavored with garlic and aromatic herbs, cooked over an open fire, with raw or cooked vegetables. The wine was locally produced and was already well regarded throughout the Mediterranean basin. Sicilian desserts were famous throughout Italy, Greece, and the Near East. Aristocratic Greek families insisted on having Sicilian cooks, and subsequently when the Romans ruled, wealthy Roman families also made sure that their food was prepared by a Sicilian. Latin writings from the ancient Romans read, “Siculus coquus et Siculus mensa” (Sicilian cooks and Sicilian cuisine). The Sicilian diet had a tremendous impact on the culture and lifestyle of the inhabitants of the Roman Empire. 

Sicily was considered the breadbasket of the Roman Empire and produced large quantities of durum wheat which was a basic staple of the diet of Sicily and of the entire Roman Empire. Puls is a dish made from farro grains flavored with salt and herbs, and was an aboriginal food made in Sicily and consumed by the ancient Romans throughout Italy and the Roman Empire. These foods were also part of ancient Roman religious’ rituals and festivals. Legumes were grown and prepared by Sicilians, and enjoyed by ancient people throughout the Roman Empire, and were a favorite food of Emperor Caesar Augustus. A famous Sicilian legume dish, maccu, prepared with fava beans, was invented by Sicilian cooks in ancient times, enjoyed by people throughout the ancient Roman Empire, and still enjoyed today, simply prepared with fennel seeds and fava beans, olive oil, salt, and pepper. 

The first known school for professional cooks was created in Sicily and the documentation of its existence is given to us by Archestratus from Gela, a Greek poet from the 4th century BCE and who is considered the father of culinary critics. 

Odysseus reports his admiration for the abundance of the Sicilian fields, beautifully described in the Odyssey (9th century BC). Plato discusses the Sicilian diet in his book, The Republic, as a diet rich in flavor which uses generous amounts of condiments and herbs. The first cookbook was written by Mithaceus of Syracuse in the 5th century B.C. 

The Romans taught the Sicilians how to make sausages, how to prepare fish and how to collect and preserve the snow from Mount Etna, a large volcano on the east coast of Sicily. The Sicilians added honey and fruit juice to the fresh snow to create the first ice cream or “gelato”. From the Romans they also learned how to dry fish by placing the fish in large containers under the sun to create anchovy paste that the Romans named Allex (thirst in Latin). Allex became the food of the peasants and slaves and it is still utilized today in the modern Sicilian cuisine. 

The Sicilians also learned the art of preserving food in salt from the Romans. The “salsamantieri” were people whose job was to preserve food under salt that was exported all over the Roman Empire. The Romans also taught the Sicilians how to make bread and the Sicilians perfected the art by adding seeds such as cumin, sesame, and poppy. The Sicilian bakers made three types of bread, dark bread made from unrefined flour, a lighter colored bread named “panis secundaris” (the second bread), and “panis candidus” (white bread) made from refined flour that was favored by the wealthy. Bread making became an art and many different breads were created, in one recipe they added wine and honey to a bread that would eventually evolve into the famous Neapolitan Babà. 

The following is a recipe from the book “De Re Coquinaria” by Marco Gavio Apicio, a Roman foodie, lover of condiments and luxury, that lived in the first century AD, during the Roman empire. This dish was commonly served in the Sicilian cuisine during the Roman time.

“ova fongia ex lacte” (four eggs, 27 ml of milk, 1 ounce of olive oil).

In 827 the Islamic conquest of Sicily began. The Arabs landed in the small town of Mazara Del Vallo situated less than 200 kilometers from north Africa. In Sicily, the Arabs did not create a unified Arabic reign but established several small lordships called kadi’.

 The Christian communities in the central and western parts of the island resisted the Islamic acculturation. They were allowed to practice their religion as long as they paid a government tax. Palermo (Balarm in Arabic) was an extraordinarily rich and opulent city under the Arabic domination. There were more than 300 mosques and a population of 250.000 habitants. (At that time, the populations in Rome and Milan were each approximately 25,000.) 

The Arabs left the greatest and most lasting impact on Sicilian food culture with the introduction of sugar cane, rice, citrus, and spices. During the Arab domination, Sicily was considered the garden of the Mediterranean. As a result of the Arabic influence, by the year 1000 the Sicilian cuisine was more advanced and sophisticated than any other European cuisine. 

The Sicilian cassata, cannoli, granite (Italian ice), sorbet and gelato were created during the time that the Arabs invaded the island. The Arabs also invented the first alcoholic beverages, however, since alcohol was forbidden by the Quran, it was used only for medicinal purposes. 

During the Islamic conquest of Sicily, the Sicilians had mastered the art of pasta making and they exported pasta to several Muslims and Christian territories outside of Sicily. 

The pasta dishes required the creation of sauces. It is believed that during the Arabic domination a particular chef was asked to feed the whole army. He created a pasta sauce made of sardines, wild fennel, and pine nuts, “Mari e Monti” (sea and mountain, because of fish and fennel and pine nuts) which is still very much enjoyed in the modern Sicilian cuisine and utilizes carbohydrates, proteins, and vegetables all in one dish. Some “malelingue” (gossiper) believe that the wild fennel was added to the sardines to mask the stench of old fish. 

The immigration of Jews and others from the Middle East occurred while the Arabs colonized Sicily. The Jews in Sicily spoke an Arabic based language. Sicily at the time had 52 “giudecche”, (Jewish neighborhoods) and 60 Synagogues. 

The Ashkenazi Jews had a simpler cuisine and introduced broths, stuffed fish, potatoes, and fruit compote into the Sicilian cuisine. The Sephardic Jews had a more elaborated cuisine like sweet and sour fish, meat and prune stew, carrot salad and cumin. The Sephardic Jews also introduced eggplant to the island and the Sicilians became experts in grilling, stuffing, frying, and incorporating the purple fruit in pasta dishes such as “pasta alia Norma” which is one of our family favorites! (fresh tomato sauce, fried eggplant, and salted ricotta cheese). This is the dish that above all others, tastes purely and sincerely like Sicily. 

The Jews taught the art of Kashrut or Kosher which means eating appropriately. They introduced the concept of sautéing garlic in olive oil which added flavor in many dishes. They taught Sicilians how not to waste any food and how to utilize even the most insignificant parts of the animal they slaughtered (feet, tongue, liver, stomach, spleen,) an idea that has had recent resurgence in America today. Today, the street vendors in Palermo still sell “pani ca’ meusa” (spleen and lung sandwich flavored with sesame.), as the Jews taught them many years ago. The Sicilian cuisine has a strong Arab-Sephardic Jewish influence. 

The Normans were an ethnic group that arose in Normandy, the northern region of France, from contact between Viking settlers and indigenous Franks, the Gallo-Romans. In 1061 the Normans conquered Sicily. They landed in Messina, a town on the northeast coast of the Island, during a period of turmoil in the Arabic domination era of the island. At this time, several other populations from northern Europe also migrated to the island. The Normans reintroduced Christianity to Sicily and they constructed churches and monasteries. They converted most of the synagogues into churches. 

The Normans greatly appreciated the Sicilian gastronomy. They brought to Sicily the art of drying fish (baccalà o Piscistoccu in Sicilian). Sicilians were awfully familiar with the art of cooking fish that was very abundant in the Mediterranean Sea, but they appreciated the dried fish for the ease of use and storage, and the high nutritious value. Today, during the winter months, when it is hard to go out at sea to fish, the Sicilians fish markets offer baccalà (dried cod fish) ready for sale as was taught to them by the Normans. The Normans also perfected the art of grilling game meat, which remains a Sicilian culinary art today. 

The Normans also introduced eating utensils to Sicilian kitchens. In medieval times, very few people owned knives. Guests would bring a spoon and a cup. The fork, introduced by the Normans, appears for the first time in the early XI century. The Spanish domination (1513-1714) introduced many new ingredients into the Sicilian cuisine, ingredients that had recently been imported from the Americas: tomatoes, peppers, potatoes, squash, prickly pear, turkey, cocoa, etc. 

Sicilians were the first to farm tomatoes for consumption. The larger distribution of tomatoes to the rest of Europe would occur several centuries later and remain a major export crop for Sicily today.

During the Spanish domination, the eggplant parmigiana was created, now famous all over the world.

 Pork was widely used and the “Pan di Spagna”, angel cake, was created to improve the taste of the Sicilian Cassata cake. Sicilian “impanate” (empanadas), cooked mostly in the eastern part of Sicily were also introduced by the Spaniards. 

The French occupied Sicily in the 1800s. From the French the Sicilians learned how to use onions instead of garlic in the preparation of refined sauces and the use of shortbread for dessert preparation.

In the 18th century the Sicilian aristocrats employed French cooks called “ Monsù “(monsieur). The Monsù were often called by their first name and the last name of the noble families they worked for. Some of them became incredibly famous and they occupied an entire apartment in the noble palace. The French and Sicilian cultures merged in the noblemen’s Sicilian kitchens. The Sicilian peasant women that helped the noble families and the monsù, worked together to create a fusion cuisine that closed the gap between the two culinary cultures. This was a rare and unusual collaboration for that era. Together they created superb dishes that utilized the best of what the Sicilian land produced (the original farm to table). Many of their creations are still used today in the modern Sicilian cuisine, such as potatoes gateaux, rice timbales filled with meat, chicken stuffed with rice and giblets. These rich dishes are usually served, and deeply enjoyed, during a Sunday family dinner. 

The peasant women that worked in the noble kitchens could not afford to buy meat for their family, so they recreated the dishes they learned from the monsù by stuffing peppers and eggplants with rice instead of stuffing meats or they used sardines, which were abundant in the Mediterranean Sea, instead of chicken or game meat. 

“Sarde a beccafico” (sardines stuffed with toasted breadcrumbs, raisins, pine nuts, today recognized as one of the traditional Italian dishes), was the peasant womens’ culinary version of stuffed game meat. 

All the many populations that conquered Sicily enriched the already rich Sicilian diet but did not alter its basic food preparation which continues to be practiced to this day. Nature and culture worked in synchrony to create one of the most diverse but coherent cuisines. 

Sicily teaches us her history through the richness and variety of her food, a history that continues to represent itself in every Sicilian table and all over the world.

 Our culinary traditions extend beyond the boundaries of Sicily, but they have been protected inside this extraordinary island.

 I am deeply grateful to all the women and men that have respected, loved, protected, and cherished our gastronomic Sicilian tradition. It is through their love of our food that I can today share with my family and all of you the joy of preparing delicious food rich with excellent nutrition.

Excerpted from The Sicilian Secret Diet Plan, UNKNO (February 1, 2021)

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