Dr. Esselstyn: “Mediterranean Diet (and Olive Oil) creates Heart Disease!”
Summary
TLDRIn this video, Dr. Gil Carvalo challenges Dr. Elstein's controversial views on olive oil and the Mediterranean diet. Dr. Elstein, a proponent of plant-based diets, argues that olive oil damages endothelial cells and impedes artery dilation. However, Carvalo refutes this by citing studies showing long-term benefits of olive oil on heart health and points out methodological flaws in Dr. Elstein's interpretation of the PREDIMED study, ultimately concluding that the Mediterranean diet reduces cardiovascular risk compared to a control diet.
Takeaways
- 📚 Dr. Elstein, a physician favoring a plant-based lifestyle, has written a paper questioning the healthiness of oil, including olive oil, and its impact on endothelial cells.
- 🔍 The paper 'Is Oil Healthy' reviews animal and human studies, suggesting that oil consumption can damage endothelial cells, which are crucial for cardiovascular health.
- 🍽️ A study cited by Dr. Elstein indicates that olive oil, compared to a low-fat high-carbohydrate meal, can inhibit flow-mediated dilation, a measure of artery health.
- 🏋️♂️ The argument against olive oil's impact on arteries is countered by the fact that exercise, which also temporarily worsens flow-mediated dilation, improves heart health in the long term.
- 🥦 Dr. Elstein notes that the effect of fats on flow-mediated dilation varies and is not consistent across all types of fats, with some showing no significant effect.
- ⏳ The timing of the impact on flow-mediated dilation also matters, with some fats showing inhibited dilation post-meal but improved dilation in long-term trials.
- 📊 A meta-analysis of 28 randomized trials shows that olive oil improves flow-mediated dilation, contradicting Dr. Elstein's argument.
- 🧠 The Mediterranean diet, which includes olive oil, has been criticized by Dr. Elstein for potentially causing cardiovascular disease, based on his interpretation of the PREDIMED study.
- 📝 The PREDIMED study actually found that the Mediterranean diet reduced the risk of cardiovascular events compared to a control diet, despite some participants experiencing events.
- 🌿 Dr. Elstein's perspective that a plant-based diet could reverse heart disease sets a high bar, and while the Mediterranean diet might underperform against it, it still offers benefits.
- 🔄 The video script emphasizes the importance of considering broader clinical data and not focusing solely on mechanisms or isolated metrics like flow-mediated dilation.
Q & A
What is Dr. Calwell Elin's view on olive oil according to the transcript?
-Dr. Calwell Elin, a physician with a history of favoring a plant-based lifestyle, discussed in an interview that olive oil causes damage to endothelial cells. He published a paper in the International Journal of Disease Reversal and Prevention in 2019, reviewing studies that show oils, including olive oil, can injure endothelial cells.
What is the role of endothelial cells in cardiovascular health?
-Endothelial cells line the arteries and are significant in blood pressure control and overall cardiovascular health. Damage to these cells can negatively impact health.
What was the main argument against olive oil presented in Dr. Elstein's review?
-Dr. Elstein argued that olive oil, among other oils, inhibits flow-mediated dilation postprandially, which he suggests damages the endothelium and should be avoided.
What is flow-mediated dilation and why is it important?
-Flow-mediated dilation is a measure of how well arteries open or widen, controlled partially by endothelial cells. It is an indicator of cardiovascular health.
What evidence did Dr. Elstein cite in his review regarding olive oil's impact on arteries?
-Dr. Elstein cited a study where researchers measured flow-mediated dilation after subjects consumed meals with different fat contents. The study showed reduced dilation after a meal high in fat, such as olive oil, compared to a low-fat, high-carbohydrate meal.
How does the transcript suggest interpreting the evidence on olive oil and flow-mediated dilation differently?
-The transcript suggests that the effect on flow-mediated dilation depends on the type of fat and timing, and that long-term studies show improvements in flow-mediated dilation with olive oil, indicating that the initial inhibition may not be a consistent or long-term effect.
What was the conclusion of the meta-analysis on olive oil and its effect on flow-mediated dilation?
-The meta-analysis, which included 28 randomized trials, indicated that olive oil improves flow-mediated dilation, contradicting Dr. Elstein's argument.
What is the Mediterranean diet and what was Dr. Elstein's opinion on it in the interview?
-The Mediterranean diet is a dietary pattern rich in olive oil, fruits, vegetables, and nuts. Dr. Elstein disagreed with a study's conclusion that the Mediterranean diet inhibits the formation of heart disease, arguing instead that it causes cardiovascular disease.
What were the findings of the large-scale randomized human trial on the Mediterranean diet mentioned in the transcript?
-The study found that the Mediterranean diet, particularly with olive oil, reduced the risk of cardiovascular events compared to a control diet with lower compliance.
How does the transcript refute Dr. Elstein's interpretation of the Mediterranean diet study?
-The transcript argues that Dr. Elstein's interpretation is incorrect because the study's data indicates a protective effect of the Mediterranean diet against cardiovascular events, rather than causing them.
What is the transcript's stance on the importance of clinical human data over mechanisms?
-The transcript emphasizes that clinical human data should be the primary focus, and mechanisms should be considered afterward to explain results, rather than the other way around.
Outlines
📚 Controversy Over Olive Oil's Health Impacts
Dr. Elstein, a proponent of a plant-based lifestyle, has expressed skepticism about the health benefits of olive oil, particularly its impact on endothelial cells. In his paper published in the International Journal of Disease Reversal and Prevention, he reviews studies suggesting that oil consumption can damage these crucial cells lining the arteries. He discusses flow-mediated dilation (FMD), a measure of artery health, and cites research indicating that olive oil may temporarily inhibit this measure post-meal. However, he also notes that the type of fat and timing can influence FMD, with some studies showing no significant effect or even improved FMD with long-term olive oil consumption. This suggests that the argument against olive oil based on FMD is not as straightforward as it seems.
🍽️ Debunking the Mediterranean Diet's Effect on Heart Disease
Dr. Elstein has challenged the widely accepted benefits of the Mediterranean diet, particularly its use of olive oil, by referencing the PREDIMED study. He argues that the study, which compared a Mediterranean diet rich in olive oil to a control diet, showed an increase in cardiovascular events in the Mediterranean diet group. However, a closer look at the study's methodology and results reveals that the participants were at high risk for cardiovascular disease to begin with, and the Mediterranean diet actually reduced the risk of cardiovascular events compared to the control group. Dr. Elstein's interpretation of the study is criticized for overlooking the overall protective effect of the Mediterranean diet and for not considering the complexity of factors contributing to cardiovascular health.
🔍 A Critical Analysis of Olive Oil and the Mediterranean Diet
This paragraph delves into a critical analysis of Dr. Elstein's views on olive oil and the Mediterranean diet. It emphasizes the importance of considering a broader range of evidence when evaluating the health impacts of dietary components. While Dr. Elstein raises concerns based on certain studies, a meta-analysis of multiple trials shows that olive oil can improve FMD over time, contradicting the idea that it is detrimental to artery health. Furthermore, the paragraph argues against focusing on mechanisms before clinical data and highlights the need for a systematic evaluation of studies. The conclusion drawn is that the Mediterranean diet, despite not being a purely plant-based diet, offers significant benefits in reducing the risk of cardiovascular events, especially when compared to diets with low to moderate fat intake.
Mindmap
Keywords
💡Olive Oil
💡Endothelial Cells
💡Flow-Mediated Dilation (FMD)
💡Mediterranean Diet
💡Dr. Elstein
💡Meta-Analysis
💡Cardiovascular Disease
💡Plant-Based Diet
💡Randomized Trial
💡High-Risk Population
💡Nutrition Made Simple
Highlights
Dr. Calwell Elin's surprising view on olive oil and the Mediterranean diet.
Dr. Elstein's background as a physician favoring a plant-based lifestyle.
Publication of Dr. Elstein's paper 'Is Oil Healthy' in 2019.
Review of animal and human studies showing oil's impact on endothelial cells.
Discussion on olive oil's effect on flow-mediated dilation and endothelial health.
Evidence presented by Dr. Elstein on olive oil's potential harm to endothelial cells.
Contrasting studies on the effects of different fats on flow-mediated dilation.
Analysis of 28 randomized trials showing olive oil improves flow-mediated dilation.
Dr. Elstein's critique of the PREDIMED study and its findings.
Misinterpretation of the PREDIMED study by Dr. Elstein regarding cardiovascular disease.
The importance of evaluating studies systematically and not relying solely on mechanisms.
Dr. Elstein's perspective on the Mediterranean diet causing cardiovascular disease.
Analysis of the actual data from the PREDIMED study showing reduced cardiovascular risk.
The role of diet in cardiovascular health alongside other factors like stress and genetics.
The broader context of olive oil's impact on overall endothelial health beyond flow-mediated dilation.
The significance of higher quality evidence in scientific discussions over individual study results.
The interview between Dr. Gil Carvalo and Dr. Elstein providing further insights.
The need for a balanced view on the Mediterranean diet and its actual health benefits.
Final thoughts on the importance of not dismissing the Mediterranean diet based on selective evidence.
Transcripts
I have to admit I was really surprised
hearing Dr calwell elin's view on olive
oil and even more so when he discussed
the Mediterranean diet Dr elstein is a
physician with a long history of
favoring a plant-based lifestyle at
least at the time of this recording in a
recent interview by Dr Gil carvalo over
at nutrition Made Simple which will be
linked for you DR elstein had well this
to say about olive oil I wrote a paper
called is oil healthy that was published
in the international Journal of disease
reversal and prevention in
2019 half of the paper was I reviewed
the animal studies that injure
endothelia cells and I reviewed the
human studies I found and that showed
that uh
animals prot that oil with injure endo3
and I C it with appropriate references
so the this is one of the main arguments
that I've heard this idea that after
eating for example olive oil flow
mediated dilation is inhibited
postprandially this is one of the
arguments that it then damages the
endothelium and so we should avoid oil
this is Gen the gist of the argument
well there's a paper in there that very
clearly shows how olive oil palm oil and
others injur ocal cells in short he
published a short scientific review of
the literature on oils and their impact
on heart disease with a special emphasis
on olive oil in this interview and in
his review Dr elstein mentions that
olive oil causes damage to the
endothelial cells if you aren't familiar
with endothelial cells they're the cells
that align your arteries and play a
significant role in blood pressure
control as well as many other areas of
cardiovascular health if they're damaged
or injured that's not a great thing for
our health so what evidence does Dr
elstein site is olive oil truly
dangerous to our endothelial cells well
in this review he cites this study
wherein the researchers measured flow
mediated dilation which is simply a
measure of how well your arteries open
or widen which is controlled partially
by endothelial cells the researchers
gave the same group of people two
different meals either a lowfat high
carbohydrate meal or a higher fat lower
carbohydrate meal with the fat content
being monounsaturated as we'd find in
olive oil they ended up showing I'll
show you the data but for some reason
it's extremely pixelated so I'll have to
draw over it in scale for you either way
you can see that the white dots
correspond to the lowfat high
carbohydrate meal and the black dots are
the higher fat meal clearly flow mediate
dilation was different at 3 hours post
po meal and greater dilation in the
lowfat group this speaks to Dr elin's
Point interestingly there's another
study directly looking at olive oil
confirming these results okay so this
measure of artery dilation indicates
olive oil impedes artery dilation now
unfortunately unless we also think that
exercise is detrimental to our health
this line of evidence is very weak
because exercise also worsens flow
mediated dilation
yet long-term exercise improves heart
health actually here's Gil making the
same point I found that the effect on on
FL mediated dilation seems to depend on
the type of fat so with olive oil they
see this inhibition right after eating
olive oil but for example with canola
oil no statistically significant effect
on fmd eating fish no significant effect
on fmd eggs also so I basically the as I
was going through this kind of
systematically this post prandial effect
seems to depend a lot on the type of fat
it's not it doesn't seem to be a a
consistent effect of fat depressing fmd
that's one thing that I that I
noticed um and then another thing uh
that I thought was even more interesting
was that it depends on the timing so
lots of things seem to affect fmd kind
of
acutely after exercise the cfmd be
depressed but then long term exercise
improves artery function and with olive
oil the same pattern after a meal we see
fmd inhibited but longterm in several
trials they see fmd improving on olive
oil interventions so it just seemed to
me that this the the fmd
argument was not very compelling based
on the evidence that I've seen agreed
all around I think Gil nailed it here
and as further proof to the point an
analysis of this very topic including 28
randomized Tri
lasting many weeks to many months
indicates as seen here that olive oil
improves flow mediated dilation I'm
going to simplify this and just point
you to the highlights here there are
different subgroups of what olive oil
was compared against but we're most
interested in the bottom Black Diamond
here which corresponds to the overall
effect all subgroups included if the
Black Diamond falls to the right it
indicates improved flow mediate dilation
with olive oil and we can clearly see
that it does and the statistics check
out as well keep in mind this was a
detected effect with only eight studies
not the full 28 and the level of
heterogen or variability in the results
was pretty low which increases our
confidence in the results I think this
is a perfect example of tiered evidence
in science remember well- conducted meta
analyses pull together many studies and
apply statistics to these studies a new
which is the top tier line of evidence
especially in randomized studies so
while Dr elstein offers some evidence if
we zoom out and include more of the
literature the picture shifts
dramatically and convincingly in
opposition to his point I have more to
say on this in a bit but let's hear what
Dr elstein has to say about the
Mediterranean diet yeah the pred study
and I I can remember there was a
reporter from The New York Times after
the paper came out that uh
called me and said Dron this seems to
disagree with your philosophy what do
you think of it and the paper and I said
well I I said I hadn't seen it so she
sent it to me and I said the title of
the paper is the medic diet inhibits
formation of heart disease they have
three groups an oil group a nut group
and then a lowfat group that was not
lowfat at all yeah and over the course
of 5 years in these 5,000 I think it was
5,000
patients uh they found
that in the oil group I forget was
something like 80 85 to 86 major events
something like 93 in that group and then
of course in the lat Group which was not
a low fat group it was like aund and
something so I I I said now I want to be
sure I because I talked her on the phone
I said
uh they're they're claiming that the
Mediterranean diet hals the progression
of heart disease but remember every
single patient who entered that study
had to be checked and be sure that they
did not have any heart disease so in
other words they had they didn't have
they didn't they were documented not
having heart disease and what I found is
in all three groups there have been
scores of Major cardiac events heart
attack stroke and death and I think
you've got the title gr the title should
be the C creation of cardiovascular
disease with the Mediterranean diet okay
so in a large scale randomized human
trial the Mediterranean diet causes
cardiovascular disease according to Dr
elstein well let's pull out our SLO
magnifying glass and pop open this study
I think it would be unfair to hold Dr
eslin to remembering all the numbers
there's no way that I remember all the
numbers of thousands of studies that
ever so let's go ahead and look at them
the study recruited over 7,000
participants and those people were put
on a Mediterranean diet with that
devilish olive oil the Mediterranean
diet with nuts or a control diet which
to Dr elin's point was not very low
dietary fat as the participants consume
30% of their nutrition as dietary fat
the study had some additional flaws or
caveats even if not flaws directly like
the fact that those on the Mediterranean
diet were more compliant than those on
the control diet meaning that they stuck
to the diet better although the
difference was rather small okay either
way does this study indicate that the
Mediterranean diet is leading to
cardiovascular disease well Dr elstein
points out that people entered the study
with no cardiovascular disease but
that's not entirely true if you read the
study here are the Baseline Health
metrics before being put on each diet
the researchers assess cardiovascular
disease at the beginning of the study by
going through medical records which
means that none of these people had a
previous history of cardiovascular
events like heart attacks but that does
not mean that they don't have for
example plaque buildup in their arteries
or high blood pressure in fact the
researchers characterized these
participants as high risk of
cardiovascular disease because the
majority were overweight and high blood
pressure and some had more than that
including half were on heart disease
medications to avoid future problems but
what about the data itself well let's
look we're looking at a chart of
cardiovascular events like heart attacks
Strokes Etc over the five years if the
lines go up that means that that group
experienced more cardiovascular events a
bad thing the control diet group is the
black line and the Mediterranean diet
groups are the the other two lines I
probably don't need to spell it out for
you but the Mediterranean die groups did
better than the control but you'll also
notice that all three experienced some
cardiovascular disease events which
seems to point in favor of Dr essel
Stein's point but is that the correct
way to interpret this data flatly no
this data indicates the Mediterranean
diet offers a protective effect reducing
the risk of card I vascular events
compared to the control and yes they
still experience cardiovascular events
but keep in mind that all of these
people were already high risk of heart
disease so everyone out of thousands not
experiencing an event over 5 years is
highly unlikely on any diet because some
damage has already been done now before
plant-based enthusiasts ethically
decapitate me in the commentary to this
video I acknowledge that Dr elstein is
speaking from a position where a purely
plant-based diet could reverse heart
disease so by that very high bar it does
seem that the Mediterranean diet would
underperform however it is still an
incorrect conclusion to State it as the
Mediterranean diet causes cardiovascular
disease for a number of reasons from it
showing improved results relative to the
control to the fact that the card
cardiovascular disease is impacted by
more than diet alone I mean think stress
arteriosclerosis factors genetics and
more the proper conclusion based on this
data is that the Mediterranean diet
outperforms a low to moderate dietary
fat diet in reducing risk of
cardiovascular events if it might
perform worse against a no oil or very
low fat or even entirely plant-based
diet is not tested here okay so where
does that leave things well while I have
respect for Dr elstein and his work I
entirely disagree with his opinion here
I want to be clear that I'm not taking
anything away from his work nor his
plant-based Focus merely disagreeing
with his interpretation of the data
considering that one there is much more
data against his perspective on olive
oil on that topic I didn't even mention
that there are many studies indicating
that olive oil improves many other
metrics of endothelial health so
focusing almost exclusively on a metric
like flow mediated dilation is frankly
baffling to me especially since flow
mediated dilation is not necessarily
just a metric of endothelial Health I
digress saer one more Point focusing on
mechanisms ahead of clinical human data
is not the order of things we focus on
higher quality evidence and if there's
an effect then we can look to mechanisms
to explain the result results not the
other way around so the flow median
dilation angle makes little sense to me
especially when we have a prime example
of how misleading it can be with
exercise and number two his
interpretation of the predimed study is
simply incorrect if we evaluate it
systematically as we should any other
study and here come the you're too young
to understand you're naive and Dr
elstein has Decades of exper experience
on you anyway I think Gil did a
wonderful job in his interview pushing
back slightly on certain points the
interview is linked in the description
and if you're so inclined check out this
next video of further science dissection
[Music]
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