#274: Breaking Up With Olive Oil with Dr. Monica Aggarwal
Rip welcomes Dr. Monica Aggarwal back to the podcast for an in-depth breakdown and discussion of her recent study on the impact of oil consumption within a whole food plant-based diet, particularly focusing on extra virgin olive oil (EVOO).
Published in the Journal of the American Heart Association, the study titled, Recipe for Heart Health: A Randomized Crossover Trial on Cardiometabolic Effects of Extra Virgin Olive Oil Within a Whole‐Food Plant‐Based Vegan Diet , revealed that individuals adhering to an oil-free whole food plant-based diet experienced greater improvements in cardiovascular markers than those incorporating extra virgin olive oil.
This intriguing finding challenges the long-held belief that olive oil, often touted for its health benefits, is a necessary component of a heart-healthy diet. This research not only highlights the efficacy of a plant-based lifestyle, but also raises important questions regarding the actual health benefits of olive oil amidst the growing trend of plant-forward eating.
As PLANTSTRONG listeners know, Rip passionately advocates for an oil-free approach, emphasizing the potential drawbacks of consuming extra virgin olive oil, which he describes as calorie-dense and highly processed.
Dr. Aggarwal also shares:
The study design and breakdown of participants
Her motivation for pursuing the study
Key findings on heart health improvements with oil-free, plant-based eating
Surprising insights into the limitations of EVOO in promoting cardiovascular health
The advantages of whole plant foods over concentrated oils
How social connections enhance dietary adherence and health outcomes
Rip and Dr. Aggarwal also discuss the need for more nutrition-focused education in healthcare, promoting a shift toward heart-healthy, whole foods.
For the PLANTSTRONG community, this study brings compelling evidence that supports our commitment to oil-free, whole food, plant-based nutrition.
Episode Highlights
0:04 Introduction to the Study
0:23 Upcoming PLANTSTRONG Retreats
0:37 The Importance of Oil-Free Living
3:01 Welcoming Dr. Monica Aggarwal
13:05 Understanding the Study's Design
15:41 The Motivation Behind the Study
17:56 Study Methods and Participant Details
22:40 Community Impact on Study Adherence
27:49 Results: LDL Cholesterol Findings
33:08 Discussion on Olive Oil
35:43 Seeking Further Research Opportunities
37:57 Debating Olive Oil's Health Benefits
44:28 Listener Questions and Expert Insight
Read the Plantstrong Blog Post About Exciting Study results
Episode Resources
Read the Our Blog Post About the Study
Read the Study from the Journal of the American Heart Association
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Full Episode Transcription via Transcription Service
I'm Rip Esselstyn, and you're listening to the PLANTSTRONG Podcast.
Introduction to the Study
[0:04] A recent study published in the Journal of the American Heart Association shows a win for oil-free, plant-strong living, and that, my PLANTSTRONG cousins, is a big kale to the yeah from us.
Upcoming PLANTSTRONG Retreats
[0:20] What exactly is the study, and what did it show? We're going to talk to one of the authors, Dr. Monica Aggarwal, and get all the details right after this message from PLANTSTRONG
The Importance of Oil-Free Living
[0:37] PLANTSTRONG family, I have some insider information for you. We are preparing to announce our 2025 retreats very soon, but as a sneak peek for you, our podcast listeners, I am thrilled to announce our spring retreat will take place in the beautiful Red Rock Mountains of Sedona, Arizona from April 6th to the 11th. And our fall retreat will take place outside of Asheville, North Carolina in majestic Black Mountain from November 9th to the 14th. If you wanna learn more, go to plantstrong.com and then click on Sedona or Black Mountain from our main menu selection. And if you wanna join, I would encourage you to take advantage of our early bird pricing just for podcast listeners. As you all know better than anyone, it's no secret that we here at PLANTSTRONG we're just not fans of added oil, including the most fabled and storied oil of them all, extra virgin olive oil. It's highly processed at 120 calories per tablespoon, and it also is incredibly calorie dense. In addition, you're going to hear today, it may not be as heart healthy as it's touted to be.
[1:59] In July of this year, the prestigious Journal of the American Heart Association published a study entitled, Recipe for Heart Health, a randomized crossover trial on cardiometabolic effects of extra virgin olive oil within a whole food plant-based vegan diet. And the results were remarkable. Participants who followed an oil-free whole food plant-based diet, well, they experienced greater improvements in heart health markers compared to those who included extra virgin olive oil in their diets. And the oil-free group also showed a more significant reduction in LDL cholesterol. As a reminder, that's the lethal cholesterol, which is crucial for reducing the risk of heart disease. Well, of course, I was curious to know more. So I invited one of the authors of the study, Dr.
Welcoming Dr. Monica Aggarwal
[2:55] Monica Aggarwal, on the PLANTSTRONG podcast to give us all the details. So let's slide right in right now.
[3:07] Dr. Monica Aggarwal, welcome back to the PLANTSTRONG podcast. It's so fantastic to see your shining face. And the last time that I had you on, you were episode 67 oh wow baby baby when your podcast was a baby i think if i'm not mistaken we were talking about this book body on fire yay that had launched um and how you basically you know uh were able to personally fight back all this bodily inflammation that you had going on in your life, right? Yeah. Uh, it's amazing to think, you know, it's been, um, my daughter is now almost 14. Uh, and this all started for me, uh, I don't know, three months after she was born. Yeah. Yeah. Um, So we have some really exciting stuff that we're going to talk about. Specifically, it's a recently published article that appeared in the Journal of the American Heart Association.
[4:15] But before we dive into that, I'd love just to kind of for those that haven't been introduced to you, that don't know about you. Let's just briefly talk about kind of who you are and what you do. So for starters, you're an associate adjunct professor at the Division of Cardiology at the University of Florida. How long have you been doing that? Yeah. So, you know, I have this crazy life, Rip, as you evidenced before we got started, because I was looking for my headphones, and I live that kind of discombobulated life. So if any of you out there are like that me, you can relate. Right.
[4:54] So I am I've been I was at the University of Florida in person for about six years or six, six and a half years. And then my husband said, you know, we need to leave our Gainesville for a couple of reasons related to his work. And we ended up in Orlando. So I still do research at the University of Florida. So when you shift, you know, when you're not there all the time, you shift from being associate professor, which is where I was. I was actually going to go for professor. And then I shifted to adjunct just because I do my research there still. I still teach medical students and fellows, but I'm not there on a daily basis. So that's why I shifted to adjunct. It's really just a terminology thing. So I have quite a I do a lot of publications and I still publish under the University of Florida. So I'm on faculty there. And how long have you had an affiliation with the University of Florida? Yeah. So I think I arrived from Malaysia in 2016 to Gainesville, Florida. So 2016 to present. Wow. What were you doing in Malaysia?
[5:53] I was teaching medical school as a, as part of a program through a Hopkins hospital. So I was living in Baltimore before that. And, um, and I was offered an opportunity to teach medical school, um, in Kuala Lumpur, Malaysia. So I took my entire family with three small children, uh, and moved to Kuala Lumpur, go figure who does that crazy stuff. I know me. And then we taught, I taught medical school. And then on the way back, I didn't want to stay, come back to Baltimore, for many reasons, but the temperature was certainly one of them. And so I was offered a great opportunity at the University of Florida. And so I took it.
[6:33] What is it about teaching medical students that is such a passion for you? You know, I've always loved to teach. You know, I'm proud that I've won many teaching awards because I do find it to be such a gratifying part of my life. Maybe because I was a struggling med student who didn't really know her way. I could have used a lot of mentorship and the people who were my mentors were just have been lifelong friends and colleagues. And so I see the value in teaching and mentorship because if we don't teach the next generation, then who the heck is, right? And and physicians are tricky people. We're super busy. We're overloaded. We're there's so many demands on us. But if we we have to make part of that priority of our of our futures, teaching, teaching the people coming ahead of us or sorry, coming after us, because, you know, especially in areas that they don't get very much education on. Right which is the nutrition which is you know the area that both of us are so interested in is nobody's teaching them nutrition and lifestyle and the impact of that and while everybody knows it conceptually nobody's actually really learning it like really learning it and so i see that as part of my role um and you know now in the past in the current and in the future i are.
[7:58] So as part of what you are teaching these medical students, is it nutrition? Is it whole food plant based? Are they and if so, are they receptive to hearing it? Yeah. So I teach a lot of the nutrition programming. I did it at the University of Florida. I do it at the University of Central Florida. I have fellows, residents and medical students from both of those places that come in round and rotate with me. I have Advent Health family physicians that rotate with me. So and what do I teach them? I teach them all sorts of nutrition. I teach them about lifestyle. I don't just focus on nutrition. I do a lot of lifestyle teaching, social connection, empathy, training. In terms of what I teach them nutrition-wise, I teach them what the data shows. So I show them the data and I let them decide. And we all know that the data supports plant-forward eating. And so we educate them that the foundation of every meal should be plant-forward. So you mentioned Advent Health there. You're also a preventive cardiologist and lipid specialist there.
[9:02] Is that online? Is there a location you go to with AdventHealth? How does that work? Yeah, I'm based in Orlando. So I see patients in Orlando. So I'm a board certified lipidologist or lipid specialist. So I deal with patients who have very complex lipid disorders, but I also have patients who come to me because they've heard about me and they, or they've been told they have advanced heart disease and they I want a second opinion. Some of them come from your dad, which is always fun when Essie sends me a patient. And so so they could be any one of those kinds of patients. But I see them in Orlando and specifically in an area called Winter Park. Hmm.
[9:40] So recently you were, were you appointed or elected? How did that work? The nutrition chair at the American College of Cardiology.
[9:50] Yeah. So the American College of Cardiology is our big society of cardiologists that we all look to for guidance, guideline management, our education. So much of it comes from the American College of Cardiology. And so recently I was elected, nominated as to be the nutrition chair, which is exciting. So, you know, I've been on that committee for several years and some of my dearest friends are on there. People like Kim Williams, Neil Barnard, Rob Osfeld, you know, friends, friends of all of ours are all on our committee. Um, and, um, uh, yeah. And so this last year or actually this summer, I was nominated to be the chair. That's great. And as the chair and as part of the American College of Cardiology, I mean, you guys are working on policy changes on the national level. Yeah. Starting nutrition. That must be pretty darn exciting. It's very exciting. It's, it's hard work. I mean, there's so much bureaucracy and infrastructure that you have to sort of overcome and, you know, But, you know, I think if we keep pushing forward, you know, you know, Neal's on the Neal's on the group and Darius Mazzaferian, and they're really interested in policy. And so having moving forward medical education and medical nutrition policy is an area of focus that I have.
[11:19] Steve DeVries, who's a great friend and is really involved in medical education. So we've just sub-appointed him as the education person. So education chair. So he's going to help me build education in medical schools, residencies, fellowships. And he's done such a great job with his Gaples Institute and really admire his work.
[11:39] And then I have a I've appointed a sub sub chair for fellows in training to sort of then help with the because I'm a strong believer, as you noted, I'm a strong believer in mentorship. And so then building up that new cohort of early, early faculty is a great joy. And so it's been fun to kind of put together these subcommittees so that we can really make impact in a few specific areas, which are passions of mine and of many of the people. I think I think it's such a massive project and people probably don't realize how massive working in this area of nutrition is because there's so many nonbelievers and there's so much misinformation out there. Right. Many people are getting their information from TikTok videos and social Instagram. And and they think that this is this is correct knowledge. And so we're fighting against that social media component. Then there's the people that are in the places who maybe don't or who maybe are involved in policy, but they may not fully understand the areas that maybe they don't have this expertise in prevention or or in nutrition.
[12:49] So our job is to then impact and educate in a very positive, supportive way, because we all are good at what we're good at. Right. And it's either many things I'm terrible at that I learned from other people. So, you know, everything is supposed to is meant to be supportive out of love,
Understanding the Study's Design
[13:04] out of all of us growing together. All right. So, Monica, let's dive into this recently published article.
[13:12] And it's called A Recipe for Heart Health, a randomized crossover trial on cardiometabolic effects of extra virgin olive oil within a whole food plant based vegan diet.
[13:29] Mouthful. It really is. But let's just so that the audience can understand, I want to, pick it apart a little bit. Yeah. A randomized, what does that mean? Randomized? What does that word mean? So you don't know when you use the word randomized, it's very important to us when we do clinical trials to randomize our people. So you don't know if you're going to get the, so in a medication trial, for instance, randomized would mean either you get the medicine or you might get the placebo. And it's important because people don't realize that so much of people feeling better is actually placebo effect. And so when you have a placebo arm, then you're avoiding or reducing that. Obviously in a nutrition trial, we don't really do a placebo effect. We don't have a placebo in the way you're thinking, but whether we, when we randomize them, we pick the people and whether they got a high or low olive oil as their first intervention was the part that was randomized.
[14:27] And then crossover, what does the word crossover mean? So again, in nutrition studies, there's so much nuance because the way I eat, the way I respond to a spaghetti squash and you respond to a spaghetti squash or, I don't know, oatmeal or something is going to be different. We have different gut bugs. We have different environmental factors. And so all of these stressors and all these things impact you versus me. And so how do I know that your LDL may be 100 and mine might be 70? You know, not to say I have no idea what your LDL is, just so we're clear. But, you know, yours might be that and mine might be 70. And then when we give you the food, then the impact on you might be different than the impact on me, right? And so it's really important in nutrition studies in particular, to use each person as their own control. So in other words, you start, when you start on your Western diet, we put them into a nutrition intervention, then they go through and we compare their data to themselves. Got it. Got it. Okay. So.
[15:33] How did this come to being? Was this your brainchild, this study,
The Motivation Behind the Study
[15:40] and why? Why do this study? It was my brainchild because I think so many years I've, you know, I'm always somebody who likes to ask questions. And so one of the things that's continued to bother me is whether, you know, so what we know about nutrition, if we step back, is that plant-forward eating is optimal for patients with heart disease. There's, there should be no debate about this. No matter if you, the keto people are wrong, the paleo people are wrong. It's a plant forward diet. And so when you look at a Mediterranean diet, which is a plant forward diet, you know, we know that there's loads of data that shows there is a reduction in events when you eat Mediterranean and it's gotten so much hype. We've had huge trials, the PrediMed study, 7,000 patients.
[16:27] We had the Leon heart study. I mean, there's just so many studies that have been showing and then more and more individual studies after that showing that the Mediterranean diet is good. But the Mediterranean diet is, you know, 30 to 40% fat, as you know. And so, and there's all these pieces in that diet that I don't really fully understand. And so then there's a plant forward diet. And what I wanted to understand, which is about 10 to 15% fat all the often, I wanted to understand, is it that everybody in the Mediterranean diet is just eating more plant forward? And that's why they're getting better? or is it that any, is any plant forward diet good for you? And if you add a little olive oil and a little bit of fish or whatever, does that matter? So I wanted to take a piece of the diet and the Mediterranean diet in particular, that's been most of interest to me, which is extra virgin olive oil.
[17:13] And I, and as you may know, in a Mediterranean diet, there's often a liberal use of extra virgin olive oil. You probably all know people that eat olive oil for their health, or they'll put it in, dip it on bread and then eat the bread and say, well, I'm eating it for my health or add it to a salad for your health.
[17:29] And so I wanted to understand specifically, does the olive oil itself, like, are there pieces of this diet that make it better? In other words, is it that we've just moved everybody to plant forward and that's why everybody's doing better? Or is there specific pieces that are like, oh, it's this piece. If you just eat anything else and you just add this piece, you're going to make people better. So that's something I've always wanted to understand. So I decided to run a study to look specifically at extra virgin olive oil.
Study Methods and Participant Details
[17:54] And so that's where that came from. Mm hmm. Well, I think it's absolutely brilliant what you were able to do. And you started all this in like 2021, probably in the middle of COVID, if I'm not mistaken. Oh, yeah, it was super hard. I mean, it's super hard to do this study. It was super hard because exactly right. We were literally doing this in the middle of an epidemic. Right. And, it went so it took longer to recruit for sure. But it was very interesting. People people love this study. We had such good adherence to our study because we had added a nuanced component of education and community that I think even I didn't fully grasp how impressive that piece was going to be. Yeah. Can you let us know? I've read it and it's super impressive, but can you let the listener know about the methods, the cohort, how many people were in the study, their ages, male, female, all that jazz? Sure, sure.
[18:56] So what we wanted to look at adults. So we really looked at anybody 18 and older, but it was really average age was about in the 60s, as is usual, most people were women, and which is also very common in studies, especially nutrition studies. We looked at patients who had at least borderline risk of heart disease. So we have a risk calculator that we as cardiologists use, we can put in your blood pressures and your cholesterol and your age, and then we can, it spits out a risk profile of low borderline. And so we wanted people who were at, had some risk features, um, of heart disease, but we also, but we didn't include people who actually had known heart disease. And that, that was, um, so we had some criteria for that. And, um, Because what I didn't want to do is I wanted to use a group of people that maybe weren't on statins and had weren't on because most of our secondary prevention patients or people of heart disease will be on statins. And so I wanted to use a cohort of people that maybe weren't on medications or weren't on statins in particular.
[19:58] So I took 40 people and I put them through a randomized crossover design study. So we took 20 people and we put 20 people that were randomized to high olive oil.
[20:08] And I'll tell you what that means in a minute. Um, and they would have, would have to eat that way. So they had to eat a hundred percent plant-based diet with high olive oil for four weeks. And then we washed it out. And then we put that same group of people, uh, on a hundred percent plant-based diet with low olive oil. When you say a one week washout, what exactly does that mean? Oh, so we put a washout in place, which means basically we ask people to go back to their old diet for that one week in between because we wanted to sort of start the numbers so if you can imagine this is the negative of crossover design is if you start here on a western diet and then you go down to here with a plant-based diet with high olive oil then then it's hard to then assess the second part of the intervention because they've already come down to here if you start here and you change just a little bit you might only see this much change does that make sense Yeah. And so with that, and so with that, you try to wash them out. So you hope that they kind of go back up so that you can still see the notable impact. But you'll see in our data, in particular, we we struggle with crossover issues, because people didn't wash out completely. And this is often a struggle in nutrition studies, because who wants to go back to those old unhealthy habits. And so what happens often is people cross over, they don't fully wash out.
[21:30] And then you see a less impact in the second part of the intervention. And we definitely suffered from that during the study. I would imagine, I mean, four weeks of eating whole food, plant-based, this, you know, low oil or, or, or even the high, the high amount, I would imagine. Wow. You probably, they probably felt so much better. Well, that's exactly it. I mean, people were so happy in the study. And remember we added this education and community component. So then you're in this group of people of eight to 10 people, which was each cohort was about eight to 10 people that you meet every week. You're on Zoom together. You're literally during some of the classes, people would pull up. They'd be like, what do I do with these oats? And then everybody else weighs in. It was this lovely community, so much so that when people finished their eight weeks, they shared numbers. They exchanged numbers so they could continue to correspond and speak to people. And these were people of different demographics, social economic status, different ethnic groups. And it was just so cool.
Community Impact on Study Adherence
[22:36] And my favorite part actually of the intervention is how much community and connection we created. And I think, again, you know, we talk about this, but I think it's so undervalued how much the content, the connection and community is to promoting adherence. Yeah. Yeah.
[22:53] Okay. So what was the difference in the amount of fat in the two groups? Well, so the high olive oil. So remember, we put everybody on 100% plant-based diet. They all were on a Western diet. We put them on 100% plant-based diet. So, you know, a huge difference already. But we were worried about the fat. And because many people will say, well, you just cut their fat. That's why you saw an improvement in their, our primary endpoint, which was LDL reduction. Now let's step back a little. What is LDL? LDL is the bad cholesterol. It's responsible for pulling atheroma or plaque inside the blood vessels. Um, we know that from the cholesterol trialist, um, study that if you drop an LDL by 39.2 milligrams per deciliter, so 39.2, you can reduce mortality or improve people's living by 22%. So it's like a surrogate endpoint. It helps you, it's sort of an outcomes, um, sort of, it can be extrapolated to outcomes. Um, so we really like an LDL reduction, um, especially when we talk about statins. Remember we talk about a 30 to 50% reduction with a moderate intensity statin. You know, we use those percentages. So using an LDL endpoint was important.
[24:06] So we gave patients 100% plant-based diet. So this is no, you know, these weren't, people were not eating processed foods. I'm sure they were some dietary and discretions, but overall they were eating plant. We provided them with oil. We gave them gift cards every week so that they could buy those plant-based foods if they were expensive. And then we put, again, that high olive oil, we'd eat about four tablespoons of oil per day. And that's a lot. It was, that was a struggle for some people because remember in the American way is not to eat so much olive oil in the Mediterranean region. It's very common and that wouldn't be considered odd. In fact, that's considered very common in the Mediterranean area. That's why we picked that number because it's been used in other studies. Whereas the American diet is more, is much less oil in that raw form, I should clarify. And we used the other low oil cohort was less than a teaspoon. So when you think about that, this oil, we wanted them to drink it. We wanted it raw. We wanted it uncooked. And so some people struggled with how to get that oil into their system for sure. Oh, I would imagine. I mean, I think just to put it into perspective.
[25:12] I'd say most Americans are probably getting three to five tablespoons of oil a day, but including in their package, their box, their canned foods, and then if they're having a salad or stir fry or whatever so interesting and and also so uh uncooked in its raw form uh and you said the high group was getting how many tablespoons a day four four four hmm so four times 120 you know do the math on that that's how many calories monica, Yeah.
[25:46] 520, right? I'm the worst at math. Well, it's 4, it's 520 calories. I mean, that's almost what, 25%, I would imagine of their daily caloric intake. And that's what makes it tricky though, too, right? Because if we're trying to do a study where we don't adjust fat significantly. So what I was trying to do was not reduce fat too much. Because if you reduce fat so much, then people will say that it's because you reduce the total fat and not because I wanted to specifically understand, is there something special about olive oil, like the phyto, the, you know, the flavonoids, the phytonutrients inside olive oil, not the flavonoids, the phytonutrients that are inside olive oil, where they in particular make this thing so special that we should be eating it on a regular. And so I wanted actually to not have such a difference in fat. Unfortunately, we did have a statistically significant reduction in fat between the high and low olive oil group, which is a criticism of the study.
[26:46] But you know, when we looked at weight loss, interestingly, it wasn't that much difference. I think it was less than a kilo per in both group between the groups. So we, we were actually fairly happy that we got even in the low olive oil group, we had the fat intake at about 32% and about in the high olive oil, it was about 42 to 45. I haven't looked at the study in a few weeks, so it may not be the exact number. Don't quote me on it. If I said 42 and it was 45, but somewhere about those numbers. And so when you, so both of those arguably are not low fat, right? And so that was important to us. So I wanted to, when we get criticism about this, like, well, you have a significant fat disparity. Yes. Yes. But both of them are fairly high fat diets and the weight difference wasn't that significant. And so what I think is important and what you show there is that it's not that because we reduced the fat so much that we saw such a significant reduction in LDL.
Results: LDL Cholesterol Findings
[27:44] Yeah, it was 48%. Thank you. And it was 32% on the low group. But how are you able to come up with that? Did you actually, were they keeping a food log of everything they were eating? Okay. Yep. We had very meticulous. So my PhD student, who's now a full-time PhD now, Dr. Andrea Krennic, it's nice to call her doctor. She's actually moved on to work in Chris Gardner's lab at Stanford, which is wonderful.
[28:10] And she was very involved in the study and hosted. She actually was the nutritionist who also ran the programming. And she did a meticulous accounting of what everybody was eating. Right.
[28:25] Well, you and I'm sure you're aware that, you know, my my father with his patients and Dean Ornish and others, they actually like, you know, they consider a low fat about 10 to 15 percent of calories. That's exactly right. And so. Right. And so that's that's what what I think is one of the pieces that makes this study so interesting is that the they didn't have a 10 percent. Right. And so, because then that's what a lot of people criticize when you eat a low fat diet. And well, of course it's low fat, you know, that's why you made an impact, but I wasn't asking that question. I was trying to specifically ask, is the olive oil itself so great? Yeah. And so what were some of the results measurements that you found as far as the benefits of doing the lower olive oil, as opposed to the higher olive oil? So first of all, we looked at a lot of clinical endpoints and markers, rather. We specifically was driven by LDL, right, which is what we talked about. But we looked at HDL, we looked at triglycerides, we looked at sugars, we looked at something called lipoprotein little a, ApoB. So for people who are sort of science nerds like me, fructosamine.
[29:34] Glucose, HSCRP, and TMAO. And a lot of the data was interesting trending and all trended in the direction of the LDL, but some of it wasn't statistically significant. The most impactful thing we found in a nutshell is that there was a more significant LDL reduction in the low olive oil group than the high. So in other words, if you were on a standard Western diet and then you went to a low olive oil group, you would have almost a 25.5 milligram per deciliter reduction in LDL. That's huge. And then if you were in the low in the high olive oil group, you only had about a 10 to 15 point drop, right? So there's a significant difference in the drop in LDL when you go low olive oil to high. And remember to remind you again, these were not people that were eating low fat, but it was the form of the fat they were getting that's most impactful. And so these people were all eating whole foods like avocados and tofu and some things that were high in fat, but they weren't necessarily high in, they weren't extra virgin olive oil and they were not things that were not affecting LDL. And so we saw a more significant reduction. They are also higher fiber. We actually look back at the amount of fiber intake. The people that were eating the low olive oil group had an excess amount of fiber in their diet, which was amazing. Which remember, we all know that fiber reduces LDL.
[31:00] Well, I mean, so none of what you've just said is really surprising to me, except I'm actually surprised that the LDL cholesterol wasn't even, it was only 10 points. I would have thought it would have been even more than that. And the reason I say that is because, you know, and Monica, I want to talk to you about this specifically when we're done talking about your trial, I just see olive oil is the equivalent of white sugar in the fat world. I don't think that there's really hardly anything beneficial about it. It's 14% saturated fat and maybe, and we know that saturated fat raises cholesterol levels and LDL. And so if people are consuming on average four added tablespoons of olive oil a day, I mean, I'm trying to think what's the.
[31:50] Substances, mechanisms in that olive oil that people are just kind of chirping about right now. Oh, I saw this study that was three years long and people that were eating olive oil did this and this. So I don't want to get off track right now on that. But so I think everything you've said makes complete sense to me.
[32:14] Yeah. I think the thing though, that there's not a more significant drop, I mean, you have to remember that people were eating this badly. And then they, you know, they, they both went plant-based, right. And so the plant-based eating is what we should be emphasizing to all of our patients. And I think that's what, what I want people to take away from this study is that we want people to eat more plant-based period. So like, there's no question that both groups, high and low olive oils, had significant improvement when they moved away from the standard diet to a plant-based diet. So we need everybody to eat plant-based. That's not just you or maybe you, and only because you have heart disease, it's everybody. And then on top of that, maybe oil and specifically extra virgin olive oil is not so great.
Discussion on Olive Oil
[33:06] And that's not something we should be adding for our health. So I, unlike you, I think, rip a little bit as I don't mind if people eat a little bit of olive oil here or there in their meals or, or not even olive oil, but oil, if they feel like they need it, but less oil is better. And I think that what I really like about this study and what I was most proud of was that this oil that you're right is considered this golden oil.
[33:30] Maybe it isn't so great. Like in this, I think that's what I want people to take away is that we're seeing a significant LDL reduction just from going plant-based, but even more so when you eat less oil and not necessarily less fat, right? Because these are people that are still eating fatty food, but they're eating it in whole form. They're eating it in whole form. And that's the key. So eat those whole foods. You don't have to cut your calories down. That's why so many of us don't say, yeah, count your calories or adjust this. We just want you to eat those whole foods, right? And so I want people to eat whole foods and I just don't want them, as you pointed out to get them in this highly concentrated form of oil.
[34:10] And to me, truthfully, I say that for all oils. And so, you know, all of the oils need to be reduced in amount because it's a concentrated form. So eat five olives, you know, eat 20 olives, you still won't get what you're getting from the four tablespoons of olive oil, right? And so it puts things into perspective that whole foods, plant-based, this is optimal for eating. There should be no debate about that. And then on top of that please don't add the oil for your health yeah yeah.
[34:40] So what are, I mean, first, how exciting that you were able to dream this up, get the funding, make it happen. And we're now, you're what, three and a half, four years later, right? Yeah, it was a long time before we got it published. But it's so cool. The Journal of American Heart Association is considered one of the best journals in the world for cardiology. And we were proud that they felt it was, despite its negatives, I mean, again, And anybody who's a scientist who's listening to this is going to say, well, these are the negatives. I agree. There were definitely issues with our crossover design, the length of the study. We needed a longer washout. I agree with all the more more finite measurement of fat intake in the future for next studies. But nobody can discount what we found. And like this is just should be the impetus for somebody to do the study again, but would double the people in a longer washout. Um, but I think that there's no question that there's a trend here that needs
Seeking Further Research Opportunities
[35:38] to be evaluated, monitored, uh, and we should be eating oils with caution. Yeah. So based upon what you put yourself through here in the last, you know, three and a half, four years, are you excited, motivated to do another study?
[35:54] I think so. I mean, you know, I'm, it's definitely, uh, research is a labor of love for sure. But it is pretty impactful stuff, right? And, you know, we debunked something or at least started the conversation about something that people have automatically assumed is good. And so we've just sort of said to the question, really, is it that good? You know, and so people haven't really asked that question. So we're proud to be one of the first people who've ever asked that question. So do I want to run the study bigger and better? Heck yeah. Do I have the funding for it? No. And unfortunately, it's very hard to get funding for nutrition studies. And so we definitely struggle with that in general. And everyone in the world struggles with funding when it comes to nutrition, because it is challenging work. And remember, there's no pharmaceutical at the end of it, where you get to prescribe a drug and yet make the money off of it, right? So that's how pharmaceuticals work. Um, but unfortunately, because it's, unfortunately it's just nutrition, right? It's just eat better. Um, but there's nothing to market there. Um, and, and if this is something that you don't want to share, I completely understand, but like, what was the budget for this study?
[37:10] Uh, I would have to check exactly, but it was over a hundred thousand, maybe 150. Oh, that doesn't actually, that doesn't sound bad. Yeah. I mean, we did it pretty bare bones, but remember we only had 40 people. Yeah. Yeah. Yeah. Right. And so if I were to do it again, I would want to do several hundred people. I would want to do a longer washout period. I would have like to have more control of fat intake. And that's always a little bit tricky, which would require dieticians to really help us in on, you know, almost within each individual. So that would take a little bit more work, but all doable. But, you know, it's expensive. Yeah.
Debating Olive Oil's Health Benefits
[37:52] If you don't mind, I'd love to talk to you right now, specifically about olive oil. And I have some questions for you. And.
[38:03] So as you heard me say earlier, I just think it's empty calories. I just literally think it's the equivalent of what white sugar is in the carbohydrate world is in the fat world. Like you said, it's the most concentrated source of calories on the planet. It's really, for the most part, got no fiber, no vitamins, minerals, phytonutrients. Now, when I ask people, what is it about olive oil that you find healthy? They typically say two things. They say it's loaded with polyphenols and it's got antioxidants. So, and I'm putting, I'm going to put you on the spot here. Like, do you have any idea how many polyphenols are in a tablespoon of olive oil? So, you know, it's interesting. Um, so I think that there's so, first of all, olive oil, olive oil and olive oil, three different olive oils are totally different, right? In terms of what the polyphenol content is, is different in all of those. So that's one thing in the study, because people have asked, we used a moderate level, a moderate level polyphenol content. And so, because we wanted to use something that people get over the counter, right? We didn't want to get something super hard to get, et cetera. So with that in mind.
[39:22] I don't know what to do with that information. Right. So that's the thing. And that's what's tricky about, you know, there are some studies out there that say that these high polyphenol count, all these are higher polyphenol count olives, olive oils. And I don't want to discount some of the studies that are out there that do show that certain olive oils are better than others, but I don't still then know what to do with that information because they're not, the studies aren't designed the way, you know, they're not put on a plant-based diet when they, when they are then given so that you could specifically look at the olive oil. Right. And so that's the problem with so many of the designs. And so when people say these are high in antioxidants and polyphenols, I'm like, Oh, okay.
[40:07] Maybe, because it's hard to know also how much that translates into actually each person, like what's bioavailant and what's not. So I do believe that because we know that olives have benefits, that there is some benefit in oils or in olive oil, but whether that's significant or not, I think this study in particular certainly doesn't show that it drives or good for LDL reduction. Now in this new study that we write we would put in new uh alzheimer's criteria would put in other criteria to show that maybe the oil and all these decision and key these other disease states was also not beneficial and i'd love to add those components to it but for now and you know i know you're putting them on the spot to say like would you you know is it and i would say to you that you know i think that there is an olive is good for you the concentrated form maybe has some nutrient quality, but is it been that impactful in heart disease? I would say no. Yeah. Well.
[41:05] And I think you said this earlier. I mean, we want everybody to eat more whole plant-based foods. And I don't, I don't know of a world where olive oil is somehow healthier than the whole food that it comes from. Right. Like this would be a no brainer. Eat the olives. If you want olive oil, eat olives. So let me, let me give you an example, because I think that, you know, I've done, I did a little research and I found it to be absolutely mind blowing when people say it's loaded with polyphenols. So obviously different olive oils will vary depending upon where it's from and all that stuff. But on average, your average 100 grams, which is 400 calories, 100 grams, which is also three and a half tablespoons, it will yield you, give you 55 milligrams of polyphenols. Okay.
[41:58] Now you could have eight olives, eight olives will give you the same amount. And that's only 50 calories. So 50 versus 400 to give you the exact same amount of polyphenols. So plus the fiber intake, right? Right. You know, think about the fiber and all the other new, I mean, yeah. So anyway, I find that to be like, okay, people are doing it. It has nothing except polyphenols. Okay, but minuscule. The other thing.
[42:28] People say is, well, it's got antioxidants. Well, it really doesn't. So you look it up. It's got zero vitamin A. Well, I mean, there's four basically things that make up antioxidants for the most part. A, C, E, and selenium. It's got zero vitamin A. It's got zero vitamin C. It's got zero selenium. And guess what? It's got trace amounts of vitamin E. And I did the math because I found it to be so fascinating.
[42:52] So guess how many milligrams of vitamin E are in one tablespoon of olive oil. Oh boy. 1.9 milligrams. Wow. So the two things, polyphenols and antioxidants, but the only antioxidants that's there is vitamin E. They're in such trace amounts that if you were to try and do that and to equate it to a whole food equivalent, you'd be having to do, you know, 16 to 32 ounces. I would just change the way you say it, Rip, and just say relative to what you can be getting from a whole food plant-based diet and those natural sources there's no comparison but you you separately olive oil yeah it's you know has some polyphenols we can't ignore that but relative to what you can get from eating plant-based foods like it's that should be the conversation i think and i think that people are more responsive to that conversation when you see it that way and the only other the only other thing i was going to say is we should write this up in like a little blog, you know, we can put in the, we can put in the study, but then we can put in these calculations you put in and then put it out there because people should see those numbers. And I thought that was really great that you put those numbers together. Yeah, no, thank you. And I just, um.
[44:10] Yeah. I, I, I, I just find it to be such a, a mind melt. Yeah. People take a little bit of polyphenols and all of a sudden it makes it into a health food.
Listener Questions and Expert Insights
[44:23] It is like we've talked about. It's just, it's crazy. So take away the right thing. Right. And so, you know, take away the right thing, which is eat more plant-based, eat lots and lots of whole foods. Don't focus on eating these concentrated forms of anything because they're not usually going to be as good as their original. Just eat the original. I mean, that's what I, we need, we need that we're the original vegetable eaters, the original gangsters were the OBs original vegetables. Yeah.
[44:50] Uh, if you don't mind, I have a couple of questions for you from, uh, from our PLANTSTRONG audience, because they knew I was going to be talking to you today. So this one comes from Pamela and she says, thank you so much for this article, Dr. Aggarwal. I understand the value of this lifestyle for cardiovascular health, but I wonder about the effect of no oil on brain health, cognitive function over time. Years ago, I had an initial consult with a cardiac wellness doctor at Montefiore Einstein Center, and he really could not answer this question for me. So I'm hoping that in 15 years, the 15 years since then, there might be more ability to answer that question. Yeah. Yeah. It's a great question. You know, I think that I would like to just say it's a non-issue, but until I do the study, I don't know for sure. You know, I think that, um.
[45:43] You know, if you look at the qualitative data and people that are eating these low fat diets, their brain functions great. Right. And so but do I have a study to sort of show that specifically about olive oil? I don't. I think people do have this obsession, though, with, you know, fat and like needing a certain amount. And people often say to my clinic, they'll say, hey, you know, I have this I need a certain amount of LDL for my brain to function or I need a certain amount of cholesterol for my brain to function. I'm like, okay, hold the phone. So when you're, you know, you need a little bit of cholesterol to build cell membranes, right? But your LDL when you're born is 40 to 50. And so you don't, if you can build, make a baby into an adult with an LDL of 40 to 50, why do we need any more than that at any other time?
[46:31] Yeah. The other thing that I would add onto that is that just because you're not adding any oil or let's say less than a teaspoon a day, as you so aptly showed in this study, doesn't mean that you're not getting any fat in your diet, right? I mean, these people were getting 32% of their calories from fat. So there's fat in everything, right? Right. And so I think we focus so much that we're going to lose brain function if we cut back too much on oils. But no, I mean, if you eat the whole foods, you're going to be just fine. Like just eat the whole foods. Your brain's going to develop fine. Everything's going to be good and fine. Will I have the clear scientific data that I can do this same study on an Alzheimer's group? It would be fun. Yeah. Dr. Aggarwal, I am oil-free, but many of my oil-free patients.
[47:22] Plant-based friends are confused about olive oil because Dr. Kim Williams and Dr. Joel Kahn both say olive oil is good due to a recent study that they read about it. Dr. Williams says a small amount is beneficial for non-overweight individuals due to the polyphenol content in olive oil. Yeah, I know exactly what he's talking about. Kim and I have talked about that study, and it's interesting. In people who are not overweight, those people did do better with a little bit of oil. I seem to remember their blood pressure was the thing that was impacted. I'd have to relook. And so Kim and I've talked about that study. Look, these are all pieces of the puzzle. And so what Kim is saying is based on this study, we know that a little bit of olive oil in these non-overweight people wasn't a bad thing, you know, but you know, 70% of the world is overweight and obese, right? And so most of the people aren't in that category. And so maybe they could eat a little bit more oil in their diet, maybe.
[48:22] But they're, you know, my study is another study that really looks at another group of people with a higher their BMI was all elevated in the overweight category. So all of these people, they're just different pieces of the puzzle. And so if you are, for instance, this underweight person, and you need to get fat, I prefer you get it from Whole Foods. But if you eat a little bit more oil, maybe there's more flexibility in your diet for you than for somebody who has a BMI of 27, and he's at risk for heart disease.
[48:53] Every case has to be taken in isolation. And, you know, I don't think that there's one rule. And, you know, Kim is, Kim and I are, you know, literally talk twice a week sometimes. And so he, we talk about these studies, and he's the first one who sent me an applause letter, applause text message to say, great job on that study. So he and I are not, they're not they're not fighting each other he's not saying olive oil is good and so wait this is debunking that and he's saying in this sub select category in this study there was a slight improvement when they had some olive oil so that's just another piece of information but again those are that you know 30 of our population who are not overweight and you know so i guess i just want people to take that with with a grain of salt too is that these are just pieces of the puzzle i think what we should take away from this is that most of, for the 70% of people that are overweight or obese, they shouldn't be eating olive oil if they're at risk for heart disease. And in general, and even with that lower weight class, why not eat them from your whole foods? Yeah. Yeah. I mean, tell me if you agree with this statement that I'm going to make here, and then I'm going to let you go. And that is, I think that olive oil and really any oil for that matter.
[50:09] It's like, it's like alcohol. I think, I think that the least amount is the most healthy amount. And, uh, with alcohol, what is it? It's like least it's a zero amount. And, um, I just, I think, I think whole food plant-based minimal to low oil is like, is it, and I don't know why there has to be all this arguing about it. Well, I think people want to live in the middles and in the, and we have a lot of gray zones and nutrition and people like the gray zone because it allows them to have certain, you know, things that they normally do. And, and, you know, I have no judgment there. I, there's certain things, I love dark chocolate, you know, so, you know, we all have sort of things that we want to kind of live in that gray zone for.
[50:51] I think that everybody should continue to take away that more plant-based is better. And if, and if you can just focus on that piece, then everything else won't matter so much. And a little bit of this or a little bit of that, I always tell people this, most people quote me a little bit of this or a little bit of that. I don't really care about as long as your foundation is plant-based. I couldn't agree with you more. The thing that obviously you can tell irks me the most is that it's, we have olive oil masking array, masking or masquerading around like it's this, this Mediterranean health food. And it's not, I just want people to know if you want to anoint it because it adds spices and you like the flavor and allow to eat more, eat more fine. But no, it's not a health food. Yeah. I think that's what you take away and, you know, do what you want with the, with the other stuff. I said, I don't sweat the small stuff. I really focus on the big picture here. And what this tells me is that a little bit of olive oil, maybe okay. A lot of oil, certainly not needed. Yeah. Yeah. Well, Monica. Such a pleasure. It really was. Thank you so much and huge congrats on getting this thank you yeah it's been great thanks so much give me a PLANTSTRONG fist bump on the way out.
[52:04] Music.
Conclusion and Key Takeaways
[52:11] I know you all can tell I am just a little passionate about this subject. Eliminating oils, even just for a short time, can have a profound effect on biomarkers, including inflammation, cholesterol, blood pressure, and weight management. This is good news, and we hope that you find this as encouraging as we do here at Plant Strong. If you found this useful, please share it with friends and loved ones who may benefit. Until next week, let's keep putting the plant back in plant-based and always, always keep it plant-strong. The PLANTSTRONG podcast team includes Carrie Barrett, Laurie Kortowich, and Ami Mackey. If you like what you hear, do us a favor and share the show with your friends and loved ones. You can always leave a five-star rating and review on Apple Podcasts or Spotify. And while you're there, make sure to hit that follow button so that you never miss an episode. As always, this and every episode is dedicated to my parents, Dr. Caldwell B. Esselstyn Jr. And Anne Crile Esselstyn. Thanks so much for listening.
