Let food be thy medicine and medicine be thy food
We’ve all heard countless times that extra virgin olive oil is the core of the Mediterranean diet, and extremely healthy. But how solid is the science surrounding olive oil? Medical pundits frequently hold forth about olive oil with faulty facts. How often have you been warned not to cook with extra virgin olive oil because heat breaks it down – despite the fact that quality extra virgin olive oil actually has a very high smoke point, and is extremely healthy? Who saw Dr. Oz, in an otherwise fairly useful segment on olive oil real and fraudulent, urge his viewers to use the “fridge test” to find out whether their olive oil was authentic? (The fridge test is based on bad science, and doesn’t work, as explained by chemist Richard Gawel here.)
Shaky olive oil science isn’t confined to TV health gurus and urban legends: sometimes it's spread by serious researchers. Hundreds of medical studies involving olive oil have been performed over the last several decades, but their methods – and the olive oils they've employed – haven’t always been the best. A recent Spanish study on the cardiovascular benefits of the Mediterranean diet, published in the New England Journal of Medicine, triggered a spate of press coverage including two articles in the New York Times (here and here). Trouble is, much of the olive oil used was donated by Hojiblanca, Spain’s largest olive oil producer/bottler, which was recently outed by the Organización de Consumidores y Usuarios, the Spanish answer to Consumer Reports, for deceptively selling an inferior grade of olive oil as “extra virgin” (summary in Spanish here). Just think how heart-healthy the study participants would have been if they’d actually been eating extra virgin olive oil, with its store of anti-oxidants, anti-inflammatories and other health-promoting substances!
Things could be worse. Three weeks earlier, a group of Scandinavian scientists published “Mediterranean Dietary Pattern and Risk of Breast Cancer”. The study revealed no correlation between Mediterranean diet and reduced incidence of breast cancer, which is surprising until you read the fine print: the sources of monounsaturated fat in their diet weren't olive oil, but meat, dairy products and “fat for food preparation and sandwiches.” As far as I can determine, participants in this “Mediterranean diet” study didn’t eat any olive oil at all, though olive oil is of course a key part of this dietary regime.
It’s time to start separating the wheat from the chaff in olive oil health, by building a canon of solid scientific information, and debugging a number of widespread olive oil misconceptions. Truth in Olive Oil has been in contact with several top medical researchers who really understand olive oil, whose research is helping to clarify how healthy extra virgin olive oil helps fight, and even cure, a number of pathologies – as well as to identify areas where olive oil isn’t actually beneficial at all. One of these researchers is Mary Flynn, PhD, RD, Associate Professor of Clinical Medicine at Brown University’s Alpert Medical School in Providence, Rhode Island. Over the last thirty years, while working as a teacher, researcher and outpatient dietitian, Mary has reviewed the existing science concerning the role of olive oil and health; performed her own research on olive oil health; created a weight-loss diet that features extra virgin olive oil; co-authored books about the fallacy of low-fat weight-loss diets (Low-fat Lies, Lifeline Press, 1999) and the health benefits of an olive oil- and vegetable-rich diet for breast cancer survivors and for people in general (The Pink Ribbon Diet, Da Capo Lifelong Books, 2010); and celebrated olive oil in culinary events with prominent chefs. In the process, she has gained a remarkable appreciation of olive oil not only as a health-promoting substance but as a delicious, uniquely satisfying food. “The sooner people realize that foods like extra virgin olive oil are medicine, pure and simple, the healthier we all will be,” she told me recently – a phrase worthy of Hippocrates.
Dr. Flynn is joining Truth in Olive Oil this week, to explain how her fascination with extra virgin olive oil was born. In future posts she’ll talk in more detail about the science behind extra virgin olive oil health, describe the weight-loss and therapeutic benefits of her olive-oil-based diet, and detail her research, past and future, into the beneficial effects of extra virgin olive oil, especially against coronary heart disease and certain types of cancer.
Truth in Olive Oil aims to raise funds for Dr. Flynn’s vital and ongoing research, as well as to help create a working group of internationally-recognized scientists and research institutes interested in exploring the therapeutic properties of high-quality extra virgin olive oil. (Details on how you can contribute to this cause will be provided in Mary's next post on Truth in Olive Oil.)
Mary Flynn, PhD, RD, Associate Professor of Clinical Medicine at Brown University’s Alpert Medical School in Providence, Rhode Island
My interest in olive oil began in 1984, when I joined The Miriam Hospital in Providence, Rhode Island, a major teaching affiliate of the Brown University medical school. The American Heart Association had just released a new set of diet guidelines which recommended that patients reduce the fat in their diet to no more than 30% of total calories. One of my tasks at the hospital was to test these guidelines by designing diets to decrease the risk of heart disease. From the beginning, I saw that as dietary fat decreased, the lipids of the patients were getting worse, with consistent increases in fasting triglycerides, and decreases in HDL (the so-called “good cholesterol”).
To understand why this was happening, I started exploring the literature on how dietary fat is related to a wide range of diseases. One of the first studies I read was the Seven Country Study led by Ancel Keys, an American epidemiologist who researched Mediterranean dietary regimes in the 1950s-1980s, and was one of the founders of the so-called “Mediterranean diet.” Keys looked at heart disease rates around the world and tried to relate them to various factors, including diet. I remember being intrigued to learn that the men on the island of Crete ate more than 40% fat, but their heart disease rate was over 80% lower than what was seen in the US. The diet fat for the men on Crete was mainly from olive oil, so I thought, “How can total fat in the diet be a health risk, if Mediterraneans eat so much olive oil and yet have low rates of heart disease?”
In subsequent years I became increasingly interested in olive oil, as I continued to read study after study that showed olive oil’s wide-ranging health benefits. Nutritional research studies routinely produce apparently conflicting results involving the same foods, often due to the study design, the participants used, or the food source of the nutrient. Yet somehow, the research on olive oil was different: studies involving olive oil have consistently revealed health benefits, and a relation to decreasing diseases. I found this fascinating, especially since at the time US health officials had begun to recommend low-fat diets to fight most chronic diseases, as well as for weight loss.
In fact, I have never supported the use of low-fat diets for any reason. In 1999 I co-authored a book for laypeople that presented the literature on low-fat diets, showing that they were neither healthy nor effective (Low-fat Lies, Lifeline Press, 1999). Low-fat diets aren’t effective for weight loss either: so long as you lower calories, the proportions of fat, protein and carbohydrates aren’t important for losing weight. What’s more, to keep weight down long-term, people have to stay on the diet, and for this to happen it helps a lot to like the diet. For me, in fact, the main problem with low-fat diets was the hunger that resulted from reducing dietary fat. Hunger is one of the main reasons people stop a weight loss diet.
Yet for reasons that I don’t fully understand, the media as well as many health officials and scientists jumped on the low-fat bandwagon, and somehow made “Mediterranean” synonymous with “fat.” I saw this in a conversation with my editor of Low-fat Lies. She asked me what diet I would recommend, and I said, “a Mediterranean diet.” Her response was, “Wouldn’t people gain weight on a high-fat diet like that?” What’s more, the label “Mediterranean diet” is widely misused, even by serious scientists. Some researchers term their diet “Mediterranean” if it includes canola oil, or has a ratio of monounsaturated to saturated fats similar to that in olive oil – even where the main source of monounsaturated fat isn’t olive oil at all, but red meat! Real Mediterraneans would never recognize such an olive-oil-free diet as their own.
I developed a weight-loss diet based on the basic eating principles observed around the Mediterranean by Ancel Keys and others, and widely practiced by Mediterranean populations today. To avoid confusion, however, I didn’t call it a “Mediterranean diet,” but a “plant-based olive oil diet” instead. It contained 2 to 3 tablespoons of extra virgin olive oil a day, which are used to cook vegetables, dress salads, dip bread, etc. Over 40% of the calories in the diet came from fat, primarily from the olive oil (as well as nuts). I thought that including olive oil at lunch and dinner would help to decrease hunger between the meals and as long as the calories were lowered, there would be weight loss. I recruited 10 women from the staff at Brown University and asked them to follow the diet for 8 weeks. From the first week of the diet they started to remark, “I am not hungry, and I am losing weight!” I invented new recipes so that they could make complete meals of olive oil, vegetables and a starch source (pasta, rice, potatoes, legumes), without having to include meat, poultry or seafood. (I don’t include meat, poultry or seafood in my recipes as these are not foods that will improve your health. In fact, their extra protein can actually lead to weight gain, as we do not store protein as protein, but break it down and store it as fat.)
My further research supported these initial findings. Around the year 2000 I set up two studies, one involving overweight people in a cardiac rehabilitation program (all had heart disease), and the other with Brown University employees who were overweight but otherwise healthy. For both studies, I randomly assigned half of the participants to my plant-based olive oil diet, and half to a conventional lower fat diet (< 30% fat). I was intrigued by the differences in the study meetings. The people on my diet were actually enthusiastic at each meeting, discussing different recipes they had tried and remarking on how delicious their meals were. Not so for the low-fat groups. One of the recurring comments from the group on my diet was again that they were not hungry and were losing weight. For both studies, my diet resulted in significantly greater weight loss than the lower fat diet. In a separate study, women on my plant-based olive oil diet lost more weight than with a lower fat diet. In addition, they had lower levels of triglycerides and higher HDL, ate significantly more vegetables, and their blood levels of carotenoids – plant pigments such as beta- and alpha-carotene and lycopene that have been linked to health benefits in humans – were significantly higher in my diet, meaning that they had more of these cancer-protective phytonutrients of these vegetables in their blood.
I teach nutrition at Brown University in the undergraduate program, and lecture on nutrition in the medical school. One of my undergraduate courses explores the literature on how food is related to chronic disease development and treatment, and the core food in the course is olive oil, because certain studies show that olive oil decreases the risk of all of the diseases we cover. This course is a lot of fun to teach, because I see students rapidly become more adept at understanding the health benefits of food, assessing the strengths and weaknesses of scientific studies, and comprehending how food can be used as medicine. It also keeps me current with the literature, especially studies of the health benefits of olive oil.
In addition to research and teaching with olive oil, I also use my olive oil diet in clinical work. In 2005 I started working with the chef of the hospital to develop recipes for the employee cafeteria, following my plant-based olive oil diet. The recipes all contained 2 tablespoons of olive oil, 2 servings of vegetables, together with whole-wheat pasta and brown rice. The meals were a success, and the chef dubbed them “Mary Meals.” Anthony Mega, MD, a medical oncologist at my hospital, liked them and subsequently asked me to develop a diet study for his patients with recurrent prostate cancer, who were being treated with androgen deprivation, a therapy that causes weight gain and the development of the Metabolic Syndrome (also known as “pre-diabetes”). We did a pilot study of 20 men who used my diet for weight loss. The average weight loss in 8 weeks was just over 11 pounds (6% of baseline weight). The majority of the men reported that they loved the diet, and were eating vegetables like spinach and broccoli that they had not eaten in years (if ever).
In several of my studies, participants had remarked on how inexpensive it was to eat my diet. I am on the board of the Rhode Island Community Food Bank, and asked the CEO if I could develop a study to see if food pantry clients who used my diet would spend less on groceries. The results of this study showed that they did in fact spend less when they used my recipes for 2 to 3 meals per week. They also improved their food security, diet quality and there was a significant weight loss for the group. This study refutes the notion that a healthy diet is expensive; it also shows that including extra virgin olive oil daily instead of meat/poultry or seafood is a very economical as well as healthy way to eat. I have also recently completed a small pilot study teaching 10- to 13-year-olds who are children of food bank clients to make meals with my recipes. The results are showing that the kids can easily make the recipes and the families are reporting eating more vegetables and whole grains, plus using extra virgin olive oil for several meals a week.
I am just starting a program to use my olive oil meals at McAuley House, a congregate meal site (a.k.a “soup kitchen”) that serves low-income and homeless individuals. The plan is to serve one olive oil meal a week and study their acceptability, cost, and ease of preparation as compared with the current meals. I’m now interviewing guests and working with the staff to lay the groundwork for our kick-off meal, which is on May 10th. I’ll be posting pictures from this event here on Truth in Olive Oil and on the McAuley House website.
I’ve been studying and working with extra virgin olive oil for thirty years, and am just beginning to sense how much we still can learn about it. Yet already I’ve come to believe that extra virgin olive oil is an amazing – indeed a near-miraculous – food. In future posts, I’ll be exploring some of its specific health benefits described in published studies, including my own research. I’ll also be detailing studies that I feel need to be done in the future, for which I’m pursuing funding. If you don’t believe it already, I hope to convince you with solid scientific evidence that including high-quality extra virgin olive oil in your diet will significantly decrease your risk of chronic disease.
What does an interventional cardiologist have to do with olive oil?
The usual day of an interventional cardiologist in the cath lab is most likely to include cases of coronary artery disease, either in its acute form (“acute coronary syndromes” that is, heart attacks or unstable angina) or in its chronic form (chronic stable angina). The interventional cardiologist uses percutaneous procedures, like balloon angioplasties and stents, along with a host of medications to open clogged coronary arteries. In no heart procedures is olive oil used!
Then what is the olive oil connection? The story of diseased heart arteries starts a few decades before the interventional cardiologist is called upon to perform any procedures. What starts the artery disease is usually either smoking or an abnormal metabolism. It is the abnormal metabolism that leads to heart disease than can be significantly affected by olive oil.
In our thirties and forties many of us, exposed to the western lifestyle (limited physical activity, processed and fast food loaded with salt and saturated and trans fats, and high-glycemic index snacks such as cookies, desserts, candies) harbor shallow cholesterol plaques in our coronary arteries. The slow time line of “atherosclerosis” (cholesterol plaque buildup in the wall of the arteries) can be suddenly and unpredictably punctuated by a “crisis” caused by an instability of the plaque. Either a “crack” or “fissure” forms on its surface or a small “bleed” takes place inside the plaque. The unstable plaque then prompts the flowing blood to form a clot at the plaque site because the blood interprets the unstable plaque situation as “bleeding” and it responds the way it is programmed to: by forming a clot.
What is truly dramatic is the time line of clot formation (“thrombosis”): it takes between one and four minutes for a clot to form inside the artery and transform a previously stable plaque that was causing little or no narrowing of the artery lumen to now become 100% occlusive. This stops the flow of blood and the nourishment of the heart or brain cells that depend on that artery abruptly ceases. The cells, then, start dying fast, resulting in a heart attack, a stroke, or sudden death. Prime risk factors for both plaque development (atherosclerosis) and plaque instability with clot formation (atherothrombosis) are:
• Metabolic Syndrome
• Genetic profile
• Aging process
While we can do nothing to counteract our heredity or our age we can do a lot to stop the other two “killers”: smoking and metabolic syndrome. Whereas olive oil (and the other features of the so called “Mediterranean diet” or “Mediterranean lifestyle”) is strongly connected with the health of our metabolism it has no smoking cessation properties, to my knowledge.
The Metabolic Syndrome is a combination of abdominal obesity (also called “visceral obesity”, “central obesity”, “apple-shape” body, or “beer belly”) along with abnormal cholesterol, abnormal sugar metabolism (pre-diabetes or type 2 diabetes), and high blood pressure (“hypertension”). It is sedentary lifestyle and an unhealthy diet that lead to metabolic syndrome. A diet is unhealthy if it contains:
• Too many calories
• Too much salt
• Unhealthy fats (saturated and trans-fats)
• High-glycemic index carbohydrates
A healthy diet, on the other hand, along with regular and adequate exercise, helps prevent or, at least, attenuate, the metabolic syndrome and atherothrombosis (heart attacks and strokes). A healthy diet is not only about what not to contain (the four categories listed above) but also about what should be included every day:
• At least five portions of fruits and vegetables
• Whole grains
• Omega-three PUFAs (polyunsaturated fatty acids found in oily fish salmon, sardines, mackerel)
• MUFAs (mono-unsaturated fatty acids found in olive oil, olives,avocado,nuts, dark chocolate)
Three quarters of olive oil consists of MUFAs (mainly oleic acid) with the rest almost equally divided between PUFAs and saturated fats. MUFAs are very beneficial for our health because they:
• reduce LDL-the “bad”-cholesterol levels in the blood
• “displace” saturated fats from the diet
• contribute to satiety (make us feel full with less amount of food)
• delay the absorption of the rest of our food, preventing fast absorption of high-glycemic index carbohydrates and, thus, prevents insulin spikes and premature hunger
• increase adiponectin, a hormone that promotes the “burning” of body fat for energy production
• contain additional beneficial substances (antioxidants and phytochemicals)
In particular, olive oil has:
• the highest content of MUFAs, as compared to other vegetable oils or nuts
• the higher oxidation threshold, so when used in deep-frying is less likely than any other vegetable oil to become partially hydrogenated (transformed to the “poisonous” trans-fats), and it
• contains a host of antioxidant phytochemicals like polyphenols (tyrosol), squalene, carotenoids, and vitamin E
Olive oil contains almost no sodium (salt) and carries about 9 calories per gram.
Metabolic syndrome and atherothrombosis (heart attacks, strokes, or sudden death) are more likely to occur when our body balance is shifted towards inflammation (proinflammatory) and clot formation (prothrombotic). Olive oil helps counteract both morbid states by virtue of its MUFAs and antioxidant content. Furthermore, antioxidants and oleocanthal counteract the neurotoxic effect of the ADDL proteins involved in Alzheimer’s disease. Olive oil also appears to have an anti-aging effect and reduce the risk of certain cancers including breast, pancreatic, stomach, laryngeal, and urinary tract cancer.
Health benefits of olive oil in specific diseases
A diet high in unsaturated fatty acids reduces blood pressure as compared to a diet rich in saturated fat. Among unsaturated fats it appears that both monounsaturated fatty acids (like those contained in olive oil) and polyunsaturated fatty acids (found in fish and other vegetable oils) lower blood pressure. An Italian research in patients with known hypertension has shown that consumptions of 40 gm of olive oil a day reduces blood pressure by about 50% (almost half of the patients were able to reduce the dose or stop taking altogether their blood pressure medications). The beneficial effect of olive oil (especially the extra virgin olive oil) is attributed mainly to its polyphenols.
Cardiovascular disease (atherosclerosis and atherothrombosis)
High LDL cholesterol contributes to atherosclerosis and atherothrombosis, depositing cholesterol in the artery wall and clogging the arteries of vital organs (like the heart, brain, and kidneys). HDL cholesterol is the “good” cholesterol and acts as a scavenger, removing cholesterol from plaques in the artery wall. Reducing LDL cholesterol and raising HDL cholesterol has significant health benefits and protects against heart attacks, strokes, and sudden death. Consumption of about two table spoons of olive oil reduced LDL (the “bad” cholesterol) and mildly raise HDL (the “good” cholesterol).
Beyond a favorite effect on LDL and HDL levels, olive oil has two more benefits that reduce heart attacks and stroke:
• It prevents oxidization of LDL which renders it more atherogenic than its non-oxidized form. This beneficial effect of olive oil on lipids is mediated through its antioxidant components, especially polyphenols and vitamin E.
• It reduces the chance of “thrombosis” (clot formation) in arteries by reducing factors that either cause clotting (plasma factor VII) or inhibit break-down of clots already formed (plasminogen activating inhibitor)
Type 2 diabetes and metabolic syndrome
Olive oil reduces the metabolic complications of type 2 diabetes and metabolic syndrome. With its polyphenols and squalene components it reduces the high level of inflammatory activity present in both diabetes and metabolic syndrome. Thus, olive oil helps reduce LDL-the “bad”-cholesterol, lipid oxidation and high blood pressure. A diet rich in olive oil also facilitates glycemic control by leaving “less room” for carbohydrates (particularly “simple sugars” that cause insulin spikes and premature hunger attacks).
Inflammation and free radicals damage brain cells and impair synaptic function, contributing to the neurodegenaration and brain cell loss that characterizes Alzheimer’s disease. The squalene content of olive oils (along with its other antioxidants) has neuroprotective effects and does not allow oxidation of its monounsaturated fatty acids (which unfortunately occurs with polyunsaturated fats that may, thus, contribute to nerve damage). Oleocanthal, another olive oil component has been shown in scientific research to slow down the progression of Alzheimer’s.
Aging and longevity
Free radicals attack and damage cells and its constituents, especially DNA found not only in the cell nucleus but also in the mitochondria. It is hypothesized that olive oil with its antioxidant effects inhibit peroxidation and reduces mitochondrial DNA damage, preserving vitality and youthfulness. It appears that the oleocanthal component of olive oil significantly contributes to olive oil’s anti-aging effects. There is a report of a 120-year-old Israeli woman who used to drink a glass of olive oil every day!
World Renown Heart Surgeon Speaks Out On What Really Causes Heart Disease
Olive Oil Polyphenols Enhance High-Density Lipoprotein Function in Humans: A Randomized Controlled Trial.