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For several years I've been spending money on Amphorra Nueavs freshly harvested high-poly olive oil and thinking this is a health food.

 

What's up? Is it, or not?

 

https://www.verywell.com/look-beyond-olive-oil-4011093?utm_content=6960215&utm_medium=email&utm_source=cn_nl&utm_campaign=livinghealthy&utm_term=

 

One of the more common myths about food that I often hear has to do with olive oil. Many people are stunned when I tell them: Olive oil is not a health food.

 

Many people have a misconception about olive oil, wrongly assuming that since it is a major source of calories in a Mediterranean diet, it must be healthy. A Mediterranean diet is rich in unrefined plant foods like vegetables, fruits, nuts, beans, and grains and includes only limited amounts of animal foods like meats and dairy.

 

However, it is the unrefined plant foods of this dietary pattern – the green vegetables, tomatoes, beans and nuts – which supply the bulk of the healthful antioxidants, phytochemicals, and minerals, not the olive oil. But, somehow olive oil has been pinpointed as responsible for the health benefits of eating a Mediterranean diet. Olive oil is a step up from butter or other animal fats, but it is inferior to whole food sources of fat. The results have been mixed on the link between olive oil and cardiovascular health. In 2014, a meta-analysis (study of many studies) evaluating observational studies of olive oil consumption reported that olive oil consumption was associated with a decreased risk of stroke but not coronary heart disease. Nut consumption, in contrast, is consistently linked to at least a 35 percent reduction in the risk of coronary heart disease.

 

A Mediterranean diet may be a bit better than the Standard American Diet, but it does not offer the dramatic protection against heart attacks, strokes, and cancers as does a Nutritarian diet.

 

A Nutritarian diet is the most effective, gold-standard of all longevity-promoting diet.

 

Olive Oil is a Fattening Processed Food

 

When most people think of processed foods, they think of chicken nuggets, hot dogs, and sugary breakfast cereals. Olive oil is never on that list. But, olive oil – like all other cooking oils – is not a whole food.

 

It, too, is a processed food, with the fiber and many beneficial phytochemicals from the original olive removed. Eat real food, not processed food. Olive oil may be better than animal fats and other oils, but it is still highly caloric and fattening; one tablespoon has 120 calories and one-quarter cup has 500 calories. Think of this the next time someone on a cooking show pours olive oil into a pan without using a measuring cup. It is very easy to add a lot of unintended extra calories to your food. The best choice is to get your fats from healthy whole food sources, such as nuts, seeds, and avocados.

 

Nuts are Superior to Olive Oil, Promote Longevity

 

An examination of the benefits of olive oil compared to nuts was tested in a side by side study called the PREDIMED study. The study compared a low-fat diet, a Mediterranean diet supplemented with olive oil, and a Mediterranean diet supplemented with mixed nuts. Both Mediterranean diets reduced blood pressure, fasting glucose levels, and total cholesterol after one year.

 

After about 5 years of follow-up, both Mediterranean diets provided substantial protection against cardiovascular events compared to the low-fat diet. However, when participants were further grouped based on their baseline nut consumption, an important difference emerged. The participants with the lowest risk of death were those that ate three or more servings of nuts a week regularly, and then were assigned to the Mediterranean diet plus nuts group. This study suggests that nuts have a stronger longevity-promoting effect than olive oil.

 

When you ingest fats from healthy whole foods you consume significantly fewer calories and get a much higher fiber and micronutrient value compared to ingesting fats from processed oils. Nuts and seeds contain 40 to 50 calories per tablespoon compared to olive oil’s 120 calories.

 

Nuts and Seeds for a Healthy Weight

 

However, when fats are ingested in the form of extracted oils, they are rapidly absorbed by the body with no fiber to slow them down, and are quickly and completely converted into body fat. If these fats were instead ingested from whole foods, such as seeds, nuts, and avocado, their absorption would be much slower, over hours, not minutes and these fats would be mostly burned for our energy needs and not stored. Also, the fibers, sterols and stanols in the seeds and nuts would bind some of the fat in the digestive tract, like a sponge, limiting the amount of fat absorbed by the body; adding nuts and seeds to the diet, despite their calorie density, promotes weight loss and healthy weight maintenance, not weight gain.

 

Top Your Salad with Nuts and Seeds, Not Olive Oil

 

Nuts and seeds, are associated with reduced cholesterol levels and dramatic protection against coronary heart disease and sudden cardiac death. Since fats help you absorb the carotenoids in vegetables, replacing the olive oil on your salad with nuts and seeds reduces cardiovascular risk and calories absorbed while still providing the maximum nutrient value from the salad. In addition to increasing the absorption of nutrients in vegetables, nuts and seeds supply their own spectrum of micronutrients including cholesterol-lowering plant sterols, minerals, and antioxidants. Plus several seeds and nuts (flax, hemp, chia, walnuts) are rich in omega-3 fatty acids, beneficial especially for brain health. Some seeds – flax, chia, and sesame in particular – are rich in lignans, plant estrogens that protect against breast cancer. Nuts and seeds also promote a healthy weight and protect against diabetes. Replacing olive oil-based dressings with vinegar, fruit and nut-based dressings are definitely the way to go. Nuts and seeds, not oil, have shown dramatic protection against heart disease in scientific studies. We need to get more of our fats from these wholesome foods and less from processed oils and animal fats.

 

Sources:

 

Domenech M, Roman P, Lapetra J, et al. Mediterranean diet reduces 24-hour ambulatory blood pressure, blood glucose, and lipids: one-year randomized, clinical trial. Hypertension 2014, 64:69-76.

 

Estruch R, Ros E, Salas-Salvado J, et al. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013, 368:1279-1290.

 

Guasch-Ferre M, Bullo M, Martinez-Gonzalez MA, et al. Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. BMC Med 2013, 11:164.

 

Kris-Etherton PM, Hu FB, Ros E, Sabate J. The role of tree nuts and peanuts in the prevention of coronary heart disease: multiple potential mechanisms. J Nutr 2008, 138:1746S-1751S.

 

Martinez-Gonzalez MA, Dominguez LJ, Delgado-Rodriguez M. Olive oil consumption and risk of CHD and/or stroke: a meta-analysis of case-control, cohort and intervention studies. Br J Nutr 2014, 112:248-259

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This looks like something written by Dr. Fuhrman (edit: noticed the link afterwards - yup it's good ole Joel!). I agree completely with the article.  I personally consume less than 0.5 tbsp of olive oil per week, opting for nuts, seeds, avocado, and cocao instead.

Edited by drewab

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Sthira,

 

Like Drew said, this seemed like a fairly well-informed, balanced article to me, as opposed to a bad article against OO from the Pritikin folks discussed here.

 

It basically articulates the health reason I chose to eat nuts, seeds and avocados as my source of healthy fats, rather than high-polyphenol EVOO. In my reading of the evidence, it appears nuts and seeds have a slight advantage over high-polyphenol EVOO in terms of health.

 

My non-health reasons for choosing nuts, seeds and avocados are cost, satiety and palatability.

 

Michael is the superhero defender of EVOO, but unfortunately even the Michael BAT Signal wasn't enough to catch Michael's attention on that thread. Maybe he'll wake up for this one, but I doubt it... ☹

 

Stay tuned for my new thread about how we might get the healthy polyphenols in high-quality EVOO without all the fat...

 

--Dean

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Dean, I already do eat nuts, seeds, and fatty fruit like avocado (are there other fatty vegetables or fruits, dear Google?)

 

Not to throw him onstage or under the bus, but Michael's writing is probably a key reason I've been so into the olive oil scene in the past four or five years. I am curious to know if the science has shifted away, or if it's just more vegan noise. Michael?

 

Should we save money and stop eating olive oil? I do love it; but if it ain't healthy then screw it.

 

(Insert Dean's funny bat call for Mr. Rae here)

Edited by Sthira

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Sthira,

 

Dean, I already do eat nuts, seeds, and fatty fruit like avocado (are there other fatty vegetables or fruits, dear Google?)

 

The King of Fruits is the next best (viable) option. Gotta love it :

 

nt8SRlj.png

 

Not to throw him onstage or under the bus, but Michael's writing is probably a key reason I've been so into the olive oil scene in the past four or five years. I am curious to know if the science has shifted away, or if it's just more vegan noise. Michael?

 

Huh? "Vegan noise?" Last I checked nuts, seeds and EVOO were all vegan.

 

Should we save money and stop eating olive oil? I do love it; but if it ain't healthy then screw it.

 

I think only whole food and/or low fat vegans would claim top-quality EVOO to be unhealthy. I consider it to be a healthy alternative to most other fats, and certainly crappy carbs and animal protein. It's just that (IMO) nuts and seeds are (marginally) healthier as well as tastier, less expensive and more satiating.

 

(Insert Dean's funny bat call for Mr. Rae here)

 

OK - you asked for it. But I warn you, it hasn't worked yet in the 3 or 4 times I've deployed it...

 

13dp8u.jpg

 

--Dean

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Thanks for the conversation, Dean. Your help is always grounding. I do eat avocados and whole olives (stuffed with pieces of garlic -- since my body hates garlic but seems to do ok with if its hidden inside a salty olive.) I eat LOADS of olives, like some days >25 a day (which maybe is overdoing it on sodium?) But I also sweat a lot, am not so great in replenishing "electrolytes" as are many of the dance people. Sometimes I'll buy pedialyte.

 

I don't eat durian because it's a time-consumer. All that hacking and blugdeoning -- I guess I probably should, though? I avoid the number one on that list you posted (banana chips -- assuming it's dehydrated junk food here?)

 

What's up with Michael, anyway? I'm guessing he's busy, and probably also lost some passion for calorie restriction after the macaque findings. He was probably as close to a guru as I've followed -- and I'm not alone -- so maybe he's avoiding us because he didn't want that unasked for potential responsibility? Guess, all, on my part.

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Sthira,

 

I avoid the number one on that list you posted (banana chips -- assuming it's dehydrated junk food here?)

 

That's good. It's worse than that - banana chips are coated in sugar and deep fried in oil. In a 28g serving of banana chips, 10g of come from added fat, almost all of it saturated... In short, banana chips are toxic junk food.

 

I highlighted in red all those so-called 'fruits' that were either redundant (i.e. other varieties of avocados & olives), fried in fat, or adulterated with mayo or other crap. All that was left in the top 25 were avocados, olives and durian. I avoid olives because of all the salt. I don't sweat that much, due (in part) to the fact I'm almost always exposing myself to some degree of cold ☺.

 

What's up with Michael, anyway? I'm guessing he's busy, and probably also lost some passion for calorie restriction after the macaque findings. He was probably as close to a guru as I've followed -- and I'm not alone -- so maybe he's avoiding us because he didn't want that unasked for potential responsibility? Guess, all, on my part. 

 

I doubt it's the latter - in my experience he's always been very willing to give candid, unequivocal advice and opinions whenever he chooses to address a question.

 

I think it's most likely that he's busy, and perhaps has lost a little bit of his former fire about CR, based on the primate CR results and his association with CR-skeptic Aubrey de Grey. I wouldn't be surprised if he and Aubrey are scrambling to keep SENS afloat, and that's keeping them very busy. Aubrey's millions have got to be running out pretty soon, and as far as I know there haven't been any public announcements of big donors who've stepped up to continue funding SENS research.

 

But I too can only speculate.

 

Perhaps our idle speculation will piss Michael off enough to respond. Such baiting is pretty much what I try to do with just about every reference I make to Michael and his views, if you haven't noticed .

 

--Dean

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[Admin Note: This and the next three posts between Michael and me are editorial comments about an off-topic digression on the ethics of eating animals that we decided to move here. Feel free to ignore them. I didn't want to delete them out of fear of offending anyone, but will if Michael agrees. --Dean]

 

Jesus H. Particular Christ.

 

Will you guys please consent to my moving all this off-topic discussion about animal rights (so-called)  and related matters unrelated to olive oil and nuts to chitchat?

 

And, Dean: in general, if someone posts something and then has the good sense to edit out some controversial and/or (in this case "and") off-topic aside in a post, it's probably good form to respect their better judgement than their initial impulse.

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Sorry Michael. Didn't realize you were paying attention...

 

Yes you have my permission at least to move the off-topic stuff from this thread to the "Animal Experiments" ChitChat thread. In fact, I promise do it for you (assuming other's permission) if you'll post something interesting to this thread - since you're the expert on EVOO polyphenols.

 

--Dean

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Sorry Michael. Didn't realize you were paying attention...

 

Yes you have my permission at least to move the off-topic stuff from this thread to the "Animal Experiments" ChitChat thread. In fact, I promise do it for you (assuming other's permission) if you'll post something interesting to this thread - since you're the expert on EVOO polyphenols.

 

--Dean

 

I originally came to this thread in order to post something interesting, in large part because you'd asked me to pay attention (I'd somehow missed this thread entirely, despite "following" General Health), only to be confronted with arguments about whether nonexistent chickens are harmed ipso facto ...

 

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Michael,

 

only to be confronted with arguments about whether nonexistent chickens are harmed ipso facto ..

 

I really like that way of describing the problem of non-existence. ☺

 

I originally came to this thread in order to post something interesting, 

 

So what stopped you? You are more than welcome at any time to bring this thread back to its original topic of the health benefits of olive oil. I for one learned by lesson not to move Sthira posts without his explicit permission. I won't be going there again...

 

--Dean

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Yeah Jesus H Particular Christ is right.

 

Michael,

 

only to be confronted with arguments about whether nonexistent chickens are harmed ipso facto ..

I really like that way of describing the problem of non-existence. ☺

I originally came to this thread in order to post something interesting,

So what stopped you? You are more than welcome at any time to bring this thread back to its original topic of the health benefits of olive oil. I for one learned by lesson not to move Sthira posts without his explicit permission. I won't be going there again...

 

--Dean

Aww cmon, man. You keep saying this. I don't give a shit about how you move my posts around and place them back into relevant threads.

 

I just ask that you not climb down and root within anyone's words and change words around to say stuff someone didn't say -- this happens frequently on Longecity -- people will edit words around and suddenly it's like, naw man, that person didn't say that shit at all.

 

When you wrote "removed references to my daughter..." this made me think, oh, this is that kinda place with d-bag criers, and I'm dealing with people who aren't very cool. Time to go. I've since changed my mind, and think you're totally cool, Dean, and you wouldn't do this -- say stuff I didn't say -- but that was then, this is now. Please move my whatever wherever you please. Have at it.

 

I posted this olive oil question because I wanted to know if the science has shifted away from olive oil being healthy, or if it's more vegan nonsense that's driving the "all-oils-should-be-avoided" advice I keep encountering here in the Lay Person world so beneath all y'all. Which is all someone like me has: lay person reads.

 

The "vegan nonsense" (poking fun at my own very serious people) ad hominem prob sent this stupid thread hurling into dunce cap dungeon.

 

Is olive oil healthy -- very plain question -- and I can search google scholar on my own, thanks, so no need to become abusive -- since I'm unaffiliated with a university I don't have access much beyond "Abstracts" (like fucking teases) to studies that I, as a taxpayer, helped paid to support, and so a lot of information (like much of this "longevity movement," is secreted away, hidden behind paywalls for all you rich people, it's for y'all, in academia, who get stuff we all paid for, for free, (another stupid side rant off topic from the question...)

 

...have new studies emerged indicating caution regarding spending my hard won cash on fancy olive oil? Is fancy olive oil another fraudulent ripoff like so much in the stupid unregulated supplement industry?

 

Post if you want; don't if you don't. Who cares. Pristine fresh olive oil is gd-expensive, I'm a struggling performance artist busy failing my way through life, and if it's not healthy I'll stop buying it from Amphora Nueva, which is my source.

 

Has new evidence indicated olive oil isn't healthy? Or is this just too mysterious and heavy-breathingly effortful to post in understandable syntax for we who aren't geniuses?

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OK Sthira (and MIchael),

 

I presume Mike C. won't mind either, so I've moved "the virtual cruelty to non-existing chickens" posts (unedited) from this thread to the animal cruelty thread starting here, and after a day or so this post itself will self-destruct. No one will be the wiser of our off-topic excursion. Hopefully Michael will keep his promise and post something useful about olive oil sooner or later.

 

Sthira, I'm glad I've done my penance for editing your post to remove reference to my daughter when I moved it to another, more topical thread. I'll never mention the incident or the bad blood it seemed to provoke between us again. I'm glad it's behind us.

 

--Dean

 

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All:
 

But, somehow olive oil has been pinpointed as responsible for the health benefits of eating a Mediterranean diet.

Um, yes, if by "somehow" they mean seven decades of scientific research culminating in a massive, randomized, multi-year controlled trial with hard outcomes ...
 

In 2014, a meta-analysis (study of many studies) evaluating observational studies of olive oil consumption reported that olive oil consumption was associated with a decreased risk of stroke but not coronary heart disease. Nut consumption, in contrast, is consistently linked to at least a 35 percent reduction in the risk of coronary heart disease.


So first: suppose for the sake of argument that EVOO consumption did absolutely nothing for you on the CHD front, but "only" prevented stroke — "the No. 5 cause of death in the United States, killing nearly 130,000 people a year (128,978) ... one in every 20 deaths ... a leading cause of long-term disability and the leading preventable cause of disability" that "more than doubles your risk of developing dementia". I'm supposed to take a "mere" reduction in stroke risk to mean that "Olive oil is not a health food," "is a Fattening Processed Food," or is at best "a step up from butter or other animal fats"?
 
And who would judge the health benefits or lack thereof of a food solely on the basis of one or two outcomes (even outcomes as important as CHD and stroke)? For instance, another meta-analysis found "that compared with the lowest, the highest category of olive oil consumption was associated with lower odds of having any type of cancer (log odds ratio = -0.41, 95%CI -0.53, -0.29, Cohran's Q = 47.52, p = 0.0002, I-sq = 62%) ... [particularly] breast cancer (logOR = -0,45 95%CI -0.78 to -0.12), and a cancer of the digestive system (logOR = -0,36 95%CI -0.50 to -0.21), compared with the lowest intake."(12) I don't want to place too much stock in this, because a lot of the studies included in this meta-analysis were in various ways weak — but there is more evidence on this point, as will be seen below.
 
And while it's not been subject to meta-analysis, multiple epidemiological studies conducted in Mediterranean countries have found that higher olive oil consumption is associated with lower risk of all-cause mortality(13-16)— the ultimate, integrated output of global health status.

I'm going to come back to this question of cherry-picking outcomes extensively below. But sticking to this meta-analysis of olive oil's associations with risk of CHD and stroke(1) for the moment: there are important methodological limitations to the studies they included.(1) One that the authors list: "the appropriate exposure to be assessed should probably be virgin olive oil instead of all kinds of olive oil mixed together". Indeed, there are tons and tons of studies showing that high-phenolic EVOO reduces multiple risk factors for chronic disease, many of them related to CVD or CHD specifically, whereas low-phenolic EVOO or refined olive oil (which has no phenolic compounds, and which is what you get if you buy either "pure olive oil" or "olive oil" with no specification in the store) has lesser or no effect. But nearly all of the studies included in the meta-analysis evaluated total olive oil, not EVOO specifically; accordingly, the meta-analysis was restricted to total olive oil exposure.

In one of the few prospective epidemiological studies to specifically segregate EVOO from total olive oil, "Olive oil intake was negatively associated with CHD risk after excluding dietary mis-reporters ["applying a methodology identifying disparities between reported energy intakes and estimated requirements"] (hazard ratio (HR) 0·93; 95 % CI 0·87, 1·00 for each 10 g/d [2 tsp] per 8368 kJ (2000 kcal) and HR 0·78; 95 % CI 0·59, 1·03 for upper v. lower quartile). The inverse association between olive oil intake (per 10 g/d per 8368 kJ (2000 kcal)) and CHD was more pronounced in never smokers (11% reduced CHD risk (P = 0·048)), in never/low alcohol drinkers (25% reduced CHD risk (P < 0·001)) and in virgin olive oil consumers (14% reduced CHD risk (P = 0·072))."(4) Sounds like olive oil — and especially EVOO — is especially good for, um, us, and less so in the general population ...

And even in this study(4), and other epidemiological studies, all they have to go on as to whether consumers are using EVOO or refined oil is the subjects' self-report. Now, this is a nigh-universal feature of epidemiological studies, and the magnitude of its likely effect is commonly exaggerated. But when considering whether someone is using EVOO or refined oil (or seed oil), it's particularly problematic. You may know whether you ate an orange or an apple, and have no problem reporting having done so, but people may say they're using EVOO when they're actually using refined oil — out of ignorance of the difference between the two (many people think "pure olive oil" is a higher grade than EVOO, when it's actually a cynical, misleading industry designation for refined oil); or because EVOO is a pricier and more high-status food; or because of the rampant fraud in the EVOO market. That is, a person reporting consistent EVOO use may indeed always purchase oils that are labeled "Extra Virgin," but may occasionally wind up with a bottle that is actually refined oil, or lower-grade unrefined oil, or doctored-up high-oleic sunflower oil (though the latter is really pretty uncommon). (Indeed, the Italian authorities nailed one of the biggest sellers of olive oil for fraudulent extra-virgin starus just two days ago ...). So the true effect of EVOO in this and other epidemiological studies is literally as well as metaphorically diluted by the inclusion of some people who report consumption of EVOO when they are actually consuming something else.

Another limitation to the studies included in the meta-analysis that they list:
 

overadjustment for intermediate mechanisms by which olive oil can reduce the risk of CHD would also attenuate the potential association between olive oil consumption and the risk of CHD. It is recognised that in an attempt to estimate the total effect of an exposure on some outcome, control for intermediate factors in the causal chain (i.e. overadjustment) will generally bias estimates of the total effect of the exposure on the outcome( 33 ). One of the mechanisms by which olive oil is suggested to work is through its effects on lipid profiles. Only two of the studies( 25 , 28 ) reported the association between olive oil intake and the risk of CHD without adjusting for serum lipid concentrations, and they found a positive( 28 ) and a negative( 25 ) association. In any case, it is noteworthy to remark that an intermediate link, such as lipid concentrations, in the causal chain should not be treated as a confounder.(1)


Ie, if you adjust for the very mechanisms by which (EV)OO reduces risk of CHD (including lipids, BP, diabetes, and adiposity), you necessarily attenuate the degree to which (EV)OO will be found to reduce risk.
 
And a more general problem with the studies included in the meta-analysis is one so generalized that the authors don't even bother to mention it: the fact that a person's behaviors and reports are always confounded in ways known and unknown, suspected and unsuspected. In epidemiological studies, people are both choosing what their lifestyle behaviors are, and choosing how to report them — and the kinds of people that engage in and report engaging in lifestyle practice X are generally different in important ways than people who don't engage in practice X or report doing so. So, famously, people who are more adherent to taking their placebo cholesterol drugs "(i.e., patients who took 80 per cent of more of the protocol prescription during the five-year follow-up period), had a substantially lower five-year mortality than did poor [placebo] adherers ... i.e., 15.1 per cent mortality for good adherers and 28.3 per cent for poor adherers."(11) This "healthy adherent effect" is thought to be because people who are more conscientious about taking their medication are also more conscientious about many aspects of their health and are likely also conscientious in ways not obviously connected to health but that none the less impact it (such as being careful with money, which can then affect the ability to afford medical care, or using condoms during sex).
 
Similarly, many epidemiological studies suggested that women taking estrogen replacement therapy were at substantially lower risk of multiple adverse outcomes in aging, most of which were either massively attenuated or torn to shreds entirely when scientists finally convinced the government to fund the controlled trials needed to really answer the question. This is thought to be a mixture of healthy adherent effect plus the fact that women who use ERT are more likely to have access to medical care generally and to be in semi-regular contact with a physician.
 
So to definitively answer these questions, you need a randomized clinical trial, where people are randomly assigned to a given intervention — medication, diet, exercise program, educational program, etc — to remove the problem of self-selection. In modern RCTs, this is done in a way that — while still narrowly random for the individual — none the less balances the characteristics of the people assigned to each intervention, so you don't get even unintentional confounding (as could happen if (eg) more people with hypertension were assigned to the placebo group in your statin trial, thereby exaggerating the statin's benefits because the placebo patients wind up suffering more heart attacks and strokes by dint of blood pressure alone).
 
As at least some of you will know, such a trial has been done for EVOO — and fortuitiously (granted the misleading nuts-vs.-olive-oil contrast and false dilemma set up by the "good" Dr. Fuhrman) also for nuts, all in the same trial!
 
The PREDIMED trial was a massive, multi-year, randomized controlled trial of a healthy diet vs. a higher-fat Mediterranean diet with either nuts or EVOO as the fat source. To ensure that people were actually taking their "medicine," subjects were not only given extensive in-person and written counseling on how to follow their assigned diets, but then followed up with annual in-person interviews on adherence to their assigned diets, but were given their nuts or EVOO  for free to ensure compliance — which was then verified with biomarker data (urinary hydroxytyrosol, the main phenolic in EVOO, for the olive oil; plasma alpha-linolenic acid for the nuts, since walnuts were one of the 3 nut types in the nut mix provided to the nut group (along with almonds and hazelnuts); and plasma oleic acid, as a marker for both EVOO and nuts).
 
The main results were published in the New England Journal of Medicine a couple of years ago:
 

Eligible participants were men (55 to 80 years of age) and women (60 to 80 years of age) with no cardiovascular disease at enrollment, who had either type 2 diabetes mellitus or at least three of the following major risk factors: smoking, hypertension, elevated low-density lipoprotein cholesterol levels, low high-density lipoprotein cholesterol levels, overweight or obesity, or a family history of premature coronary heart disease. ... The primary end point was a composite of myocardial infarction, stroke, and death from cardiovascular causes. Secondary end points were stroke, myocardial infarction, death from cardiovascular causes, and death from any cause. ...
 
A total of 7447 persons were enrolled (age range, 55 to 80 years); 57% were women. The two Mediterranean-diet groups had good adherence to the intervention, according to self-reported intake and biomarker analyses. ... [T]he trial was stopped after a median follow-up of 4.8 years. ... A primary end-point event occurred in 288 participants. The multivariable-adjusted hazard ratios [for the composite of myocardial infarction, stroke, and death from cardiovascular causes] were 0.70 (95% confidence interval [CI], 0.54 to 0.92) and 0.72 (95% CI, 0.54 to 0.96) for the group assigned to a Mediterranean diet with extra-virgin olive oil (96 events) and the group assigned to a Mediterranean diet with nuts (83 events), respectively, versus the control group (109 events).(8)


 

ramon-et-al-cvd-risk1.jpg


Now, what of the charge that EVOO is just "a step up from butter or other animal fats, but inferior to whole food sources of fat"? Well, first, if that were true, then (a) MedDiet+nuts would have fared better than MedDiet+EVOO, and (b) any benefit of MedDiet+EVOO as compared to either the controls or the nut group would be linked to a greater reduction in SaFA out of the diet of the MedDiet+EVOO group than the others. But neither of these was true.
 
For starters, you can see above that on the primary outcome, EVOO did just as well as nuts. And the results can't be argued to be the result of a crappy control diet: whether assigned to lower-fat healthy diet advice, MedDiet+EVOO, or MedDiet+nuts, all three groups had similar scores on a standard “Mediterranean diet” score: 8.7 on the two MedDiets and 8.4 in the controls, with a major difference being of course use of EVOO and nuts, both of which are contributors to the score! Moreover, all three brought their saturated fat intakes down to a little over 9% of energy intake — a level not only lower than the average American’s 11% of energy, but lower than the AHA’s limit of 10% of Calories for the general population, albeit somewhat higher than the 7% of Calories recommended for high-risk patients and survivors of past CVD events. And notably, the people on the control diet also cut back substantially on consumption of red and processed meat, which is both a source of SaFA and unhealthy for other reasons.
 
Additionally, this wasn't just EVOO selected randomly off of the grocery store shelf. The oil was provided for free by two Spanish olive oil cooperatives, so we know right off the bat that it was authentic. The oil used in the study consistently had a respectable level of phenolic compounds, albeit not quite as high as I would prefer: an average of 326 mg/kg oil, and not less than 300 mg/kg in any given year.
 
And while we don't have data on the oleic acid content, it's also likely to have been good, for two reasons. First, most of the low-phenolic olive cultivars — notably Arbequina, Chemlali, and Chétoui — also tend to be low-oleic (and thus  high-palmitic and/or high-linolenic), so the reasonably-high phenolic content of this oil suggests it is likely to also have had a decent level of oleic acid. Second, except for the premium market, the Spanish olive oil industry leans very heavily on the very high-oleic Picual cultivar, which accounts for over 50% of the industry; the second most-used cultivar, Hojiblanca, also tends to have a decent oleic acid content, and the Chemlali and Chétoui cultivars are almost never used.
 
And importantly, the study oils were provided fresh every winter, so no one was using the two-year-old dregs of a  once-decent but now phenolic-depleted, peroxidation-product-laden oil.
 
What about the supposed "inferior[ity of EVOO] to whole food sources of fat"? Well, again, as you can see above, the EVOO group did pretty much identically on the composite primary outcome as nuts. But when you break it down, there are plenty of outcomes where people assigned to EVOO in PREDIMED either appeared to, or definitely did, fare better not only than the controls, but better than those assigned to MedDiet+nuts. In secondary analyses of PREDIMED:

• EVOO was more effective than nuts at slowing the rate of age-related cognitive decline(18), and EVOO but not nuts reduced the risk of developing mild cognitive impairment,(2) the somewhat euphemistic term for preclinical dementia.

• Amongst the men, "The total osteocalcin concentration [marker of bone formation] increased robustly in the MedDiet+VOO group (P=0.007) in parallel to increased [procollagen I N-terminal propeptide] levels [another such marker] (P=0.01) and homeostasis model assessment-β-cell function (P=0.01) but not in subjects on the MedDiet+nuts (P =0.32) or after the control diet (P= 0.74)"(3) — when both bone health and β-cell function (the leading or tied-for-first explanation for the curious phenomenon of CR-associated impaired glucose tolerance) are "issues" of specific concern to CR folk.
 
• "Multivariate-adjusted hazard ratios [for diabetes] were 0.60 (95% CI, 0.43 to 0.85) for the Mediterranean diet supplemented with EVOO and 0.82 (CI, 0.61 to 1.10) for the Mediterranean diet supplemented with nuts compared with the control diet."(10) Note the confidence intervals: it's not even totally clear that MedDiet+Nuts did protect against diabetes risk, and if it did, the effect was clearly less.

• MedDiet+EVOO reduced the risk of atrial fibrillation by some 38%; MedDiet+Nuts exhibited no protective effect.(19) Afib is scary shit, especially as people age: as explained here, Afib is usually silent in people over the age of 65, and if you have it, you're twice as likely to die and five times more likely to have a stroke than people without it. And if you have Afib and do suffer a stroke, it's more than twice as likely to kill you — and if you survive it, an Afib-driven stroke leads to "much larger and much greater disability than non-AF strokes". See also here and here.

• In the women (Liz? Judy? You guys out there?), the MedDiet+EVOO dramatically reduced the risk of breast cancer, while the effect of nuts was either only half as great if there was one, and quite possibly didn't happen at all (again, note the confidence intervals): "The multivariable-adjusted hazard ratios vs the control group were 0.32 (95% CI, 0.13-0.79) for the Mediterranean diet with extra-virgin olive oil group and 0.59 (95% CI, 0.26-1.35) for the Mediterranean diet with nuts group. In analyses with yearly cumulative updated dietary exposures, the hazard ratio for each additional 5% of calories from extra-virgin olive oil was 0.72 (95% CI, 0.57-0.90)."(9)
 
Additionally, when the investigators on the main report looked at the individual components of the composite cardiovascular score, the trends certainly suggested that EVOO was not only equally protective as nuts against heart attack:
 

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... but more protective (indeed, evidently exclusively protective) against (drumroll) total mortality:
 

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Now, both of those effects were statistically nonsignificant trends, so it's entirely reasonable to be initially dismissive of them. I think in this case, however, they have to be taken seriously, for a couple of reasons.
 
First, PREDIMED was actually stopped prematurely. This was the result of a surprising confluence of events, and that confluence gives us one kind of reason to think that the trends in MI and total mortality would have become statistically significant if the trial had been allowed to continue for its full original duration.
 
When you design a clinical trial, you have to decide how many subjects to include. If you want to get a reliable result, this means having enough subjects in each group that a statistically significant difference between the groups has a fair chance of emerging if the effect is real. Of course, you don't know in advance what the number of events in any group will be, so this is normally done by calculating the expected rate of the outcome without treatment based on previous trials and population data of patients with similar risk factors for the outcome of interest, and then how many subjects would be needed for an intervention with a reasonable effect size to have a reasonable chance of emerging in a reasonable amount of time.
 
In this case, the PREDIMED statisticians "estimated that a sample of 9000 participants would be required to provide statistical power of 80% to detect a relative risk reduction of 20% in each Mediterranean-diet group versus the control-diet group during a 4-year follow-up period, assuming an event rate of 12% in the control group." But then five years after the very first patients were enrolled, the independent data monitoring board had a peek at the data, and found that far fewer control subjects were suffering events than would have been anticipated. So the first takeaway is that the observed differences between the MedDiet groups (+EVOO or +nuts) and the controls were actually more impressive than the numbers suggest, because the control group was itself doing substantially better than would be predicted of a similar population — in part, perhaps, because their adherence to the control diet was good (except for barely nudging their total fat intake), and was giving them more protection than might have been anticipated based on their risk factors alone.
 
To ensure that the trial had a fair chance of showing any benefit, then, the statisticians decided that they would have to let the trial run longer than originally intended: based on the low rate of cardiovascular events amongst the controls and the slow rate at which they'd been able to recruit subjects, "the sample size was recalculated as 7400 participants, with the assumption of a 6-year follow-up period and underlying event rates of 8.8% and 6.6% in the control and intervention groups, respectively."
 
But then, after the average recruit had been following hir assigned diet for an average of 4.8 years, the review panel took another peek of the data, and saw that while the controls were continuing to fare better than expected, the MedDiet groups were doing even better still — and the difference in the primary outcome was so clear that the ethics board determined that it would be unethical to keep the subjects randomized to the control diet for another year or more, when the benefits of the MedDiets were so clear. So they shut down the trial.
 
So the first reason to take the statistically nonsignificant trends toward lower risk of MI in both MedDiet groups and of total mortality in MedDiet+EVOO seriously is that the reduced nominal event frequencies were in comparison to control subjects that were already suffering fewer heart attacks, strokes, and CVD deaths than would have been expected, and that the interventions weren't given the full intended time to show their effect even if they had. Given more time and more events in the controls, you would certainly expect the observed trends would have reached the point of statistical significance. (And, of course, we're in this for the long haul, not just 4-6 years).
 
The second reason to take those trends seriously when the statistical test implies otherwise is that many of the ways that EVOO (and nuts) are thought to protect against cardiovascular disease were mostly taken off the table by drug therapy. Remember what the authors of the meta-analysis of olive oil and cardiovascular outcomes mentioned above about overadjustment?
 

overadjustment for intermediate mechanisms by which olive oil can reduce the risk of CHD would also attenuate the potential association between olive oil consumption and the risk of CHD. It is recognised that in an attempt to estimate the total effect of an exposure on some outcome, control for intermediate factors in the causal chain (i.e. overadjustment) will generally bias estimates of the total effect of the exposure on the outcome( 33 ). One of the mechanisms by which olive oil is suggested to work is through its effects on lipid profiles. ...  In any case, it is noteworthy to remark that an intermediate link, such as lipid concentrations, in the causal chain should not be treated as a confounder.(1)


Ie, if you adjust for the very mechanisms by which (EV)OO reduces risk of adverse outcomes (including lipids, BP, diabetes, and adiposity), you necessarily attenuate the degree to which (EV)OO will be found to reduce risk. Well,a similar thing was done in a much more powerful way in PREDIMED: not by statistical adjustment, but by treating subjects for these risk factors with drugs.
 
This, again, is an ethical requirement in modern clinical trials: when you have patients in your care, it's unethical not to give them the best proven medical care that you can, even if you're simultaneously trying to test whether an unproven therapy will benefit those same patients. So in the PREDIMED trial, all the subjects (controls or either MedDiet) were given medications to counteract their risk factors: those with high LDL got statins, hypertensives got BP meds, diabetics had their diabetes treated, etc. But of course, part of the reason why EVOO (and nuts) are expected to reduce the risk of CHD, MI, stroke, and total mortality is exactly by improving the lipid profile, reducing BP, reducing the risk of diabetes, and so on! So their potential benefitcial effects were pharmacologically minimized.
 
And remember, too: the control diets were actually doing a pretty good job of eating a Med Diet themselves: on a standard “Mediterranean diet” score, subject in the two MedDiets scored 8.7, while the controls scored 8.4, with a major difference being of course use of EVOO and nuts.
 
Yet MedDiet+EVOO it still managed to decisively reduce total cardiovascular events and many other outcomes. In a case like that, the clear-looking trends of a protective effect against total mortality and heart attack risk need to be taken much more seriously than they would be if it were left to diet alone to protect subjects against major cardiovascular risk factors — and all the more so since, again, the event rate in the controls was lower than expected to begin with, and the trial was stopped over a year earlier than intended based on that low event rate.
 
 
So do all of these actual and apparent superior outcomes for EVOO over nuts mean nuts are "not a health food," but "a Fattening Processed Food," or are at best "a step up from butter [balls]"?
 

Macadamia%20Nuts%20hero-c2d92870-a929-49
 

Butter+balls+4.JPG?format=500w
 

Of course not! There's tons of evidence that nuts are good for you, and there are other outcomes in PREDIMED where nuts came out as well or better than EVOO. You should eat both — I certainly do.

Now, as promised, let's return to the meta-analysis with which we started.(1) Fuhrman accurately summarized the results as finding that "olive oil consumption was associated with a decreased risk of stroke but not coronary heart disease." As seen extensively above, both epidemiology and the gold standard of medical evidence show that this is only a very small slice of the benefits associated with olive oil consumption, and especially EVOO. But on the narrow question: in fact, PREDIMED is consistent with the notion that EVOO is at least more effective at preventing stroke than CHD per se — but contrary to Fuhrman's insistence that nuts must be superior to this "fattening processed food," the same was true for nuts:
 

CMD_AotM_April14_Figure1.png
"

 
 
 
As we've just seen, both MedDiets in PREDIMED reduced the risk of the primary outcome: a composite score of myocardial infarction, stroke, or death from cardiovascular causes. CHD itself was not evaluated, but certainly CHD is a major driver of heart attacks, and as discussed above, there was a strong-looking trend for nuts and EVOO to similarly protect against MI, and for EVOO exclusively to reduce all-cause mortality. What is unambiguous, however, is that both MedDiet+EVOO and MedDiet+nuts did reduce the risk of strokes, as the meta-analysis found even for total olive oil.
 

[Olive oil], too, is a processed food, with the fiber and many beneficial phytochemicals from the original olive removed. Eat real food, not processed food.


EVOO (a) is by legal definition a minimally-processed food — just mechanically-separated oil, done at low temperatures, hardly comparable to Ding Dongs — and (b) also has a different mix of phytochemicals from the original fruit, some of which may be unique to it, including 3,4-DHPEA-EDA and 3,4-DHPEA-EA, which are formed in the malaxation (extended paste-mixing) process after the olives are crushed, due to the rupture of cell walls and some of the pits, and the interaction of enzymes with the liberated phenolics from which they are normally segregated. See (17), section 2.2.1., "Qualitative Changes."
 
IAC, "Eat real food, not processed food" is a convenient rule-of-thumb for an overall dietary pattern, and for individual foods in the absence of knowledge, but we have overwhelming evidence that EVOO is a health-promoting food (and, as it happens, very little evidence at all on the long-term health effects of whole olive consumption, tho' (7) did find a "25% decrease in the risk of major [cardiovascular] events in the top tertile of baseline olive fruit consumption after adjusting for potential confounders (HR: 0.75; 95% CI: 0.55 to 1.01, P for trend = 0.10)" in PREDIMED).
 

Many people have a misconception about olive oil, wrongly assuming that since it is a major source of calories in a Mediterranean diet, it must be healthy. ... However, it is the unrefined plant foods of this dietary pattern – the green vegetables, tomatoes, beans and nuts – which supply the bulk of the healthful antioxidants, phytochemicals, and minerals, not the olive oil.


Now, wait: one minute they're bitching about EVOO allegedly being processed food; now they're falling into the very essence of "nutritionism," focused on a food's micronutrients rather than its actual effects as a whole food. And, to the extent that one is going to talk about bioactives, one must be specific: it's silly to just talk about the summed "bulk of the healthful antioxidants, phytochemicals." One wants to know what phytochemicals, and what the food matrix is, and why one should pay attention to that particular bioactive and not another. Lycopene ≠ EgCG ≠ capsaicin ≠ oleuropein, and it's silly to just sum them up.
 

Olive oil may be better than animal fats and other oils, but it is still highly caloric and fattening; one tablespoon has 120 calories and one-quarter cup has 500 calories. Think of this the next time someone on a cooking show pours olive oil into a pan without using a measuring cup. It is very easy to add a lot of unintended extra calories to your food. The best choice is to get your fats from healthy whole food sources, such as nuts, seeds, and avocados.


Um, except that there are multiple epidemiological studies showing that fat intake, even in an AL diet, has no specific association with weight gain in the general population (tho' there may be a gene-by-diet relationship by FTO genotype, driven by Calories, not fat) — and in PREDIMED in particular, both the EVOO-enriched MedDiet and the nut-enriched MedDiet led to a very small weight loss, not weight gain, and a reduction in waist circumference, despite there having been no weight or energy targets in the trial.(5)
 
OTOH, I'd agree that it's far too common for TV chefs and home cooks to blithely "pour olive oil into a pan without using a measuring cup." So? Use a damned measuring spoon!
 

when fats are ingested in the form of extracted oils, they are rapidly absorbed by the body with no fiber to slow them down, and are quickly and completely converted into body fat.

If these fats were instead ingested from whole foods, such as seeds, nuts, and avocado, their absorption would be much slower, over hours, not minutes and these fats would be mostly burned for our energy needs and not stored.


Does anyone seriously believe that 100% of Calories from liquid fats are quickly and completely converted into body fat? Or even that absorbed fats from nuts and avocado are "mostly burned and not stored," full stop, without consideration of activity or overall energy balance?? Much of Fuhrman's post is misleading or partial; this particular bit is just outright B.S. And again: five years of consuming MedDiet+EVOO and MedDiet+nuts, consumed ad libitum, led to no weight gain, and even modest weight loss.(5)
 

An examination of the benefits of olive oil compared to nuts was tested in a side by side study called the PREDIMED study. The study compared a low-fat diet, a Mediterranean diet supplemented with olive oil, and a Mediterranean diet supplemented with mixed nuts. ... After about 5 years of follow-up, both Mediterranean diets provided substantial protection against cardiovascular events compared to the low-fat diet. [Yet EVOO is a "fattening processed food"?? -MR] However, when participants were further grouped based on their baseline nut consumption, an important difference emerged. The participants with the lowest risk of death were those that ate three or more servings of nuts a week regularly, and then were assigned to the Mediterranean diet plus nuts group. This study suggests that nuts have a stronger longevity-promoting effect than olive oil.


Er, no, it doesn't — because in the substudy they're referring to,(6) they don't do the reciprocal analysis for olive oil! The study was on baseline nut intake and mortality, and while they included the group x baseline nut intake for all three groups in the trial to account for ongoing nut exposure, they just didn't do an equivalent analysis of the same relationship  as regards baseline EVOO as assigned to MedDiet+EVOO (or nuts or control). (6) provides no data on whether baseline and ongoing nuts' protective effect is equal to, greater than, or less than doing the equivalent analysis for EVOO.

The closest they came to doing that was (7), where they evaluated baseline olive oil consumption only on mortality, without considering the specifics of the  additional 5 years of diet randomization. They did, however, interestingly find that those who had high baseline (EV)OO intake seemed to get additional benefits on major CVD outcomes when assigned to nuts during the trial:
 

Participants in the highest energy-adjusted tertile of baseline total olive oil and extra-virgin olive oil consumption had 35% (HR: 0.65; 95% CI: 0.47 to 0.89) and 39% (HR: 0.61; 95% CI: 0.44 to 0.85) cardiovascular disease risk reduction, respectively ... [and a] 48% (HR: 0.52; 95% CI: 0.29 to 0.93) reduced risk of cardiovascular mortality.  ...
 
The HR and 95% CIs for the association between EVOO, CVD and also for mortality are presented in Table 3. Baseline EVOO consumption was inversely associated with major cardiovascular events after adjusting for potential confounders (39% lower risk (HR: 0.61; 95% CI: 0.44 to 0.85 (P for trend <0.01)). ...
 
The reduction in the risk of major cardiovascular events according to tertiles of total baseline olive oil intake separated by intervention group were 57% (HR: 0.43; 95% CI: 0.25 to 0.75, P for trend <0.01) and 55% (HR: 0.45; 95% CI: 0.25 to 0.82, P for trend <0.01) in the groups of MedDiet supplemented with EVOO or nuts, respectively. In contrast, the risk in the low fat control group was increased by 9% (HR: 1.09, 95% CI: 0.63 to 1.88, P for trend = 0.24) (P-value of homogeneity test: 0.178). The association between major events and EVOO intake showed relative risk reductions of 41% (HR: 0.59; 95% CI: 0.32 to 1.07, P for trend = 0.050), 63% (HR: 0.37; 95% CI: 0.20 to 0.71, P for trend <0.01) and 15% (HR: 0.85; 95% CI: 0.51 to 1.41, P for trend = 0.503) in the MedDiet supplemented with EVOO, nuts and control group, respectively (P-value of homogeneity test: 0.364).
 
A non-significant inverse association between baseline EVOO consumption and mortality outcomes was found, specifically for overall mortality. [in fact, there was also an NS trend for reduced CVD mortality (0.93 (0.84, 1.03)  and as we have seen, during the trial itself, MedDiet+EVOO seems to have reduced total mortality, whereas nuts did no -MR]. We observed non-significant associations between the baseline intake of common olive oil and major events and mortality (Table 4).(7)

 
But, again, they did not then extend baseline (EV)OO intake into ongoing consumption in the trial diets for total mortality,(7) as was done in the nut study,(6) so there is 5 years of (EV)OO unaccounted for on that front: the data are just not directly comparable. And unlike during PREDIMED itself (when, again, the EVOO group was given free, authentic, reasonably high-phenolic EVOO), the baseline data on olive oil type is by self-report, with all the limits discussed above on extra-virgin status.
 
Extra-virgin olive oil: healthy. Dogmatic vegan nutjob MDs: not.

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2: Martínez-Lapiscina EH, Clavero P, Toledo E, San Julián B, Sanchez-Tainta A, Corella D, Lamuela-Raventós RM, Martínez JA, Martínez-Gonzalez MÁ. Virgin olive oil supplementation and long-term cognition: the PREDIMED-NAVARRA randomized, trial. J Nutr Health Aging. 2013;17(6):544-52. doi: 10.1007/s12603-013-0027-6. PubMed PMID: 23732551.

3: Fernández-Real JM, Bulló M, Moreno-Navarrete JM, Ricart W, Ros E, Estruch R, Salas-Salvadó J. A Mediterranean diet enriched with olive oil is associated with higher serum total osteocalcin levels in elderly men at high cardiovascular risk. J Clin Endocrinol Metab. 2012 Oct;97(10):3792-8. doi: 10.1210/jc.2012-2221. Epub 2012 Aug 1. PubMed PMID: 22855341; PubMed Central PMCID: PMC3462931.

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5 Estruch R, Martínez-González MA, Corella D, Salas-Salvadó J, Fitó M, Chiva-Blanch G, Fiol M, Gómez-Gracia E, Arós F, Lapetra J, Serra-Majem L, Pintó X, Buil-Cosiales P, Sorlí JV, Muñoz MA, Basora-Gallisá J, Lamuela-Raventós RM, Serra-Mir M, Ros E; PREDIMED Study Investigators. Effect of a high-fat Mediterranean diet on bodyweight and waist circumference: a prespecified secondary outcomes analysis of the PREDIMED randomised controlled trial. Lancet Diabetes Endocrinol. 2016 Jun 6. pii: S2213-8587(16)30085-7. doi: 10.1016/S2213-8587(16)30085-7. [Epub ahead of print] PubMed PMID: 27283479.

6: Guasch-Ferre M, Bullo M, Martinez-Gonzalez MA, et al. Frequency of nut consumption and mortality risk in the PREDIMED nutrition intervention trial. BMC Med 2013, 11:164.

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8: Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med. 2013 Apr 4;368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25. PubMed PMID: 23432189.
http://dx.doi.org/10...6/NEJMoa1200303

9: Toledo E, Salas-Salvadó J, Donat-Vargas C, Buil-Cosiales P, Estruch R, Ros E, Corella D, Fitó M, Hu FB, Arós F, Gómez-Gracia E, Romaguera D, Ortega-Calvo M, Serra-Majem L, Pintó X, Schröder H, Basora J, Sorlí JV, Bulló M, Serra-Mir M, Martínez-González MA. Mediterranean Diet and Invasive Breast Cancer Risk Among Women at High Cardiovascular Risk in the PREDIMED Trial: A Randomized Clinical Trial. JAMA Intern Med. 2015 Nov 1;175(11):1752-60. doi: 10.1001/jamainternmed.2015.4838. PMID: 26365989

10: Salas-Salvadó J, Bulló M, Estruch R, Ros E, Covas MI, Ibarrola-Jurado N, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Romaguera D, Lapetra J, Lamuela-Raventós RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez-González MA. Prevention of diabetes with Mediterranean diets: a subgroup analysis of a randomized trial. Ann Intern Med. 2014 Jan 7;160(1):1-10. doi: 10.7326/M13-1725. PubMed PMID: 24573661.

11: Influence of adherence to treatment and response of cholesterol on mortality in the coronary drug project. N Engl J Med. 1980 Oct 30;303(18):1038-41. PubMed PMID: 6999345.
 
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13: Buckland G, Mayén AL, Agudo A, Travier N, Navarro C, Huerta JM, Chirlaque MD, Barricarte A, Ardanaz E, Moreno-Iribas C, Marin P, Quirós JR, Redondo ML, Amiano P, Dorronsoro M, Arriola L, Molina E, Sanchez MJ, Gonzalez CA. Olive oil intake and mortality within the Spanish population (EPIC-Spain). Am J Clin Nutr. 2012 Jul;96(1):142-9. doi: 10.3945/ajcn.111.024216. Epub 2012 May 30. PubMed PMID: 22648725.

14: Trichopoulou A, Bamia C, Trichopoulos D. Anatomy of health effects of Mediterranean diet: Greek EPIC prospective cohort study. BMJ. 2009 Jun 23;338:b2337. doi: 10.1136/bmj.b2337. PubMed PMID: 19549997; PubMed Central PMCID: PMC3272659. "The contributions of the individual components of the Mediterranean diet to this association were ... high monounsaturated to saturated lipid ratio 10.6% ... higher ratio of monounsaturates to saturates is considered to be beneficial and reflects the high olive oil consumption that characterises the traditional Mediterranean diet. ... Whenever we excluded one or more factors from the Mediterranean diet score, we still adjusted for these factors in the statistical analyses to control for possible confounding. Moreover, when we evaluated the two by two combinations, we controlled for the rest of the components of the original score." These included "Meat and meat products" and "Dairy products" (Tables 3 and 4), ie, the major contributors to SaFA intake, leaving the MUFA-to-SaFA ratio as even more ddriven by the dominant MUFA source — ie, olive oil.

15: Barzi F, Woodward M, Marfisi RM, Tavazzi L, Valagussa F, Marchioli R; GISSI-Prevenzione Investigators. Mediterranean diet and all-causes mortality after myocardial infarction: results from the GISSI-Prevenzione trial. Eur J Clin Nutr. 2003 Apr;57(4):604-11. Erratum in: Eur J Clin Nutr. 2003 Aug;57(8):1034. PubMed PMID: 12700623. See Table 2: RR for "regular" vs. "never/sometimes" olive oil consumers after adjustment for other dietary factors was 0.71 (CI 0.60 – 0.84), P-value for trend 0.002, and was 0.76 (0.64 – 0.91), P-value for trend 0.010, when adjusted for both dietary and non-dietary factors.

16: Solfrizzi V, D'Introno A, Colacicco AM, Capurso C, Palasciano R, Capurso S, Torres F, Capurso A, Panza F. Unsaturated fatty acids intake and all-causes mortality: a 8.5-year follow-up of the Italian Longitudinal Study on Aging. Exp Gerontol. 2005 Apr;40(4):335-43. PubMed PMID: 15820615. In this study cohort, “85% of [monounsaturated fatty acid intake] derived from olive oil.”
 
17: Talhaoui N, Gómez-Caravaca AM, León L, De la Rosa R, Fernández-Gutiérrez A, Segura-Carretero A. From Olive Fruits to Olive Oil: Phenolic Compound Transfer in Six Different Olive Cultivars Grown under the Same Agronomical Conditions. Int J Mol Sci. 2016 Mar 4;17(3). pii: E337. doi: 10.3390/ijms17030337. PubMed PMID: 26959010; PubMed Central PMCID: PMC4813199.
 
18: Valls-Pedret C, Sala-Vila A, Serra-Mir M, Corella D, de la Torre R, Martínez-González MÁ, Martínez-Lapiscina EH, Fitó M, Pérez-Heras A, Salas-Salvadó J, Estruch R, Ros E. Mediterranean Diet and Age-Related Cognitive Decline: A Randomized Clinical Trial. JAMA Intern Med. 2015 Jul;175(7):1094-103. doi: 10.1001/jamainternmed.2015.1668. PubMed PMID: 25961184.
 
19: Martínez-González MÁ, Toledo E, Arós F, Fiol M, Corella D, Salas-Salvadó J, Ros E, Covas MI, Fernández-Crehuet J, Lapetra J, Muñoz MA, Fitó M, Serra-Majem L, Pintó X, Lamuela-Raventós RM, Sorlí JV, Babio N, Buil-Cosiales P, Ruiz-Gutierrez V, Estruch R, Alonso A; PREDIMED Investigators. Extravirgin olive oil consumption reduces risk of atrial fibrillation: the PREDIMED (Prevención con Dieta Mediterránea) trial. Circulation. 2014 Jul 1;130(1):18-26. doi: 10.1161/CIRCULATIONAHA.113.006921. Epub 2014 Apr 30. PubMed PMID: 24787471.

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Amazing breakdown of the PREDIMED study, MR - congratulations! And I can see it must have been a ton of work - but well worth it!

 

And since you already did all that work, if I could just piggyback a couple of questions which hopefully can rely on the work you already did (thus not adding excessively to your research burden):

 

1) I am troubled by the EVOO question in the PREDIMED study. They were giving the oil away for a lengthy period of time. As we know all too well, EVOOs are not created equal when it comes to phenolic content, oleic acid etc. - do we have the profiles of the EVOO through time (since obviously even if the sources didn't change, there is variation from harvest to harvest) - I would like to know WHAT EXACTLY were they consuming in their EVOO? It strikes me as a pretty fundamental question. I am not satisfied with a generic "EVOO" answer.

 

2) Directly proceeding from the previous point, what is your take on the idea of brewing olive leaves for the polyphenolic content? There's a whole thread devoted to this idea (which I've christened Dean's Witches Brew!), though I don't expect you've had the time to look at it carefully if at all. If indeed the claim that "olive leaves have the same phenolic content as EVOO, except in larger amounts" is true (and that can obviously be in dispute), then this poses an interesting question - you mention oleuropein, which is richly represented in olive leaves extract (and available through brewing olive leaf powder) - can't this at least in part replicate the benefits of EVOO? Of course, I realize that EVOO is not just oil + polyphenols, but there are other things like oleic acids and possibly substances not present, or present in a different matrix in the olive leaf products, but what is your take in principle wrt. brewing such?

 

Thanks in advance! 

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Michael,

 

I want to second Tom's kudos for your tremendously helpful analysis of the merits of EVOO. This is yet another time where I wish we had post feedback emojis enabled like on Longecity.org, which I'm advocating for here, but which others seem surprisingly indifferent about. There are been several instances in the last few days (e.g. on the Ultimate Purpose of Life thread) where I really wish I could acknowledge my appreciation of posts (in this case by Thomas & Sthira) without cluttering up the thread with content-less "thank yous". But I digress.

 

You seem to have come to the same conclusion that I have (contra the low-fat, vegan "nutjob MDs" that we both recognize have an agenda to promote - however noble it might be), namely that authentic, carefully processed and stored EVOO is indeed very healthy. I'm just concerned about the hassle, expense and uncertainty surrounding sourcing, vetting & storing EVOO to ensure one gets those full benefits.

 

So I second Tom's questions, particularly the one about the potential for getting the full complement of EVOO polyphenols from alternative (much less expensive per serving) olive leaf products - namely using olive leaf extract (OLE), or dried olive leaves or olive leaf powder (OLP) either consumed whole or brewed into tea, as suggested on this thread.

 

Thanks,

 

--Dean

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And I wonder how much EVOO love is placebo: clearly human expectation is a potent force, potent enough to challenge in either direction, pro or con, the powers of diet, exercise, drugs...

 

Anyway, I like Michael's post because, like Dean's, it offers actionable response. I'll continue to buy fancy olive oil (unregulated, trust-based, expensive, wastefully shipped, adding to carbon feats) because I like olive oil, I believe real olive oil is healthy (although I welcome the challenge that it's not healthy) and I tend to eat more leafy greens when I have high poly stuff around. But I agree with Dean that it's an expensive PITA to deal with the good stuff.

 

Still unanswered is my original query: is there any new science indicating olive oil is either healthy or not, and I'll take it that the answer is no, nothing new here?

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Wow Michael thank you so much for this! I will continue to enjoy my evoo from Amphora Nueva which is a real delight added to my garden salads. It ain't cheap, but I do not see it as a major hassle. Simply go to the state store here in PA and for a few bucks buy a pump and stopper kit and pump the air out of the bottle after each use. These pumps are also available online.

 

I would also like to add that I totally agree with Dean on the feedback emoji issue. We are all humans here and when we appreciate a post we should not be put in the position of being outcasts for simple acknowledgement of appreciation.

Edited by mikeccolella

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All:
 

I am troubled by the EVOO question in the PREDIMED study. ... EVOOs are not created equal when it comes to phenolic content, oleic acid etc. ... obviously even if the sources didn't change, there is variation from harvest to harvest) - I would like to know WHAT EXACTLY were they consuming in their EVOO? It strikes me as a pretty fundamental question. I am not satisfied with a generic "EVOO" answer.


Huh ... that's of course an important question, and I know I had originally included info on this very subject; I must have somehow  dropped  it in moving things around during drafting. I've edited it into my post above; search "326" to find a reconstruction.
 

what is your take on the idea of brewing olive leaves for the polyphenolic content? There's a whole thread devoted to this idea ... If indeed the claim that "olive leaves have the same phenolic content as EVOO, except in larger amounts" is true (and that can obviously be in dispute) ... you mention oleuropein, which is richly represented in olive leaves extract (and available through brewing olive leaf powder) - can't this at least in part replicate the benefits of EVOO? Of course, I realize that EVOO is not just oil + polyphenols, but there are other things like oleic acids and possibly substances not present, or present in a different matrix in the olive leaf products, but what is your take in principle wrt. brewing such?

 
Well, you've largely answered the question yourself with the various objections I bolded in quoting you above; see also "also has a different mix" in my post above. For additional details and documentation, see "OFFLIST: polyphenol content in olives", the email I sent to you in response to this very question, dated 2011/04/08 ;) . (Please don't just copy-paste it or (for now) forward it to anyone (nothing personal, Dean!): I will endeavor to get something up in the olive leaf thread, but IAC, as I say, the essence of the answer is a mixture what's already here, plus the blatantly obvious but evidently heretofore-unstated.
 

And I wonder how much EVOO love is placebo: clearly human expectation is a potent force, potent enough to challenge in either direction, pro or con, the powers of diet, exercise, drugs...


Well, again, the power of expectation is part of placebo effects, which are largely accounted for by this being a randomized trial. Of course, the difference is that in a placebo-controlled trial, one can't tell the difference between verum and placebo, whereas you can certainly tell whether you're consuming olive oil, or nuts, or removing the skin from your chicken. But in a placebo-controlled trial, the assumption is that the drug does something and the placebo does nothing (except inasmuch as your mind does something in response to both placebo and verum), whereas here the expectation for all three groups is that the diet they've been assigned is beneficial.

 

Additionally, such problems are at least in part addressed by shorter-term controlled trials with high- and low-phenolic olive oils: yes, you can usually taste the difference, but it wouldn't be obvious to most people to expect more benefit from the more bitter-tasting, peppery oil: in fact, in blind taste tests and in questionnaires about the characteristics of high-quality oils, most people assume that such oil is rancid, or at least of poorer quality than milder, fruitier, lower-phenolic oil(1-5).
 

I'll continue to buy fancy olive oil (unregulated, trust-based, expensive, wastefully shipped, adding to carbon feats) because I like olive oil, I believe real olive oil is healthy (although I welcome the challenge that it's not healthy) and I tend to eat more leafy greens when I have high poly stuff around. But I agree with Dean that it's an expensive PITA to deal with the good stuff.


"Trust-based": well, VF does provide CoAs. "Wastefully-shipped:" Amphora and others will ship in 10 L cubes, and some have 1 gallon tins: both options are much lighteer and take up much less space in a shipment, reducing carbon impact and shipping cost. Expensive: true enough — but "relative to what?" Fresh fruit & veg is more expensive than pasta and a vitamin pill, but that's not the game we're playing. And it does amortate pretty favorably at 2-3 T/d ...
 

Still unanswered is my original query: is there any new science indicating olive oil is either healthy or not, and I'll take it that the answer is no, nothing new here?

 
 Now, are you just trying to get my goat, or is there a substantive question behind that apparent taunt?
 
References
1. Recchia A, Monteleone E, Tuorila H (2012) Responses to extra virgin olive oils in consumers with varying commitment to oils. Food Qual Preference 24(1):153–161. http://dx.doi.org/10.1016/j.foodqual.2011.10.009
 
2. A. Gámbaro, A. Ellis and L. Raggio, "Virgin Olive Oil Acceptability in Emerging Olive Oil-Producing Countries," Food and Nutrition Sciences, Vol. 4 No. 10, 2013, pp. 1060-1068. doi: 10.4236/fns.2013.410138.
 
3. Predieri, S., Medoro, C., Magli, M., Gatti, E., & Rotondi, A. (2013). Virgin olive oil sensory properties: comparing trained panel evaluation and consumer preferences. Food Research International, November 2013. 54(2):2091-2094. DOI: 10.1016/j.foodres.2013.08.014
 
4. Delgado C., Guinard J. (2010) How do consumer hedonic ratings for extra virgin olive oil relate to quality ratings
by experts and descriptive analysis ratings?, Food Quality and Preference 22(2): 213-225. doi: 10.1016/j.foodqual.2010.10.004

 

5. T Del Giudice, C Cavallo, F Caracciolo, G Cicia. What attributes of extra virgin olive oil are really important for consumers: a meta-analysis of consumers’ stated preferences. Agricultural and Food Economics 3 (1):1-15. http://link.springer.com/article/10.1186/s40100-015-0034-5
"On the production side there has been a trend toward oils which, thanks to innovations in production techniques introduced over the past two decades, result in a product with enhanced sensory characteristics (pungent, bitter, fruity, etc.). On the consumption side, because of the strong link with traditional preferences and thanks to the educational role played by branded products and GDO private labels toward tasting, there is now a generation of EVO users who seem to prefer a product with a quite plain, neutral taste, generating a serious split in the market (Leonetti et al. 2009; Santosa et al. 2010; Mtimet et al. 2008, 2011, 2013; Caporale et al. 2006; Delgado and Guinard 2011, 2012; Delgado et al. 2013; Recchia et al. 2012; Bevilacqua et al. 2012; Del Giudice et al. 2012)."

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Molte grazie, MR for the work and the reminder about the email (I will of course honor your wishes wrt. not forwarding, or sharing etc.) - I have located the email, and now I remember something that I couldn't quite put my finger on before: in another thread here I mentioned how I once asked you about consuming olives and my ideas as to why that might be beneficial and your answer persuaded me that my idea was mistaken... only I could not remember where that exchange took place and a search turned up nothing. Well, it turns out, that exchange was OFF LIST, and was this very email series you mentioned! I will note that it dealt with a slightly different part of the plant, than what's being discussed in the present thread, but I can easily see how the same reasoning applies, and therefore accept that as dispositive. 

 

By the by, I must say I have been a happy customer of Amphora Nueva for many years now, and have had many fun-filled exchanges with Nate. I have absolute confidence in the integrity of their product and business practices. Having been spoiled rotten by their EVOO over the years, I shudder every time I'm presented with supposedly excellent EVOO in some restaurant or food-fair. Alas, my palate has been permanently spoiled when it comes to EVOO. Actually, the expense is not the biggest problem with it - it's the storage hassle... I have a friend with a professionally equipped (at great expense!) wine cellar temp/humidity/light controlled, where I store the bulk of my EVOO upon receipt from AN (and pouring into dark bottles); I then have to make a run to his cellar every time I run out of a bottle (fortunately he lives a stone's throw from me). And the anxiety of pouring into bottles from the 10L cube! I worry about oxygen and air bubbles and all sorts of things as I pour. A nightmare.

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By the by, I must say I have been a happy customer of Amphora Nueva for many years now, and have had many fun-filled exchanges with Nate. I have absolute confidence in the integrity of their product and business practices. Having been spoiled rotten by their EVOO over the years, I shudder every time I'm presented with supposedly excellent EVOO in some restaurant or food-fair.

Me, too, there, Tom. I've been a little bummed by all the anti-olive oil shiz I've been reading in vegan-pop, so I really didn't want to have to give up that their oils are healthy oils. These posts by Michael are happy and welcome for me.

 

I have to buy it by the indie bottle, though, I'm just not competent enough to deal with these messy cubes y'all are sweating.

 

And Michael Rae I'm only pulling collar because like Dean and everyone else here I really miss your posts. Even if I'm not quite smart and educated enuf to grasp all your painfully wrought details, I am smart enough to act on well-researched waxy and fluctuating conclusions. But it wouldn't surprise me if there was a sudden thought reversal and whoops the healthiness of pristine oil is . Ain't nothin' conclusive about nothin -- including that idea, I guess.

 

Post more, Michael. Even if they're not epic life-changing posts, most of us are prob nearly as busy and torn as you're.

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Does anyone know how high-quality Pompeian olive oil (https://www.amazon.com/Pompeian-Extra-Virgin-Olive-Oil/dp/B003VKQT9C/ref=sr_1_6_s_it?s=grocery&ie=UTF8&qid=1468028350&sr=1-6&keywords=olive+oil ) is?

 

It seems more astrigent-y than other OOs I've tried, which I think is a good sign relative to other brands of OO...

 

 

I can't say whether or not the brand is high quality, but the fact that their product isn't even organic is a strike against the standards they hold for their product.  

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