Dr. Esselstyn: “Mediterranean Diet (and Olive Oil) creates Heart Disease!”

Summary

In 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

00:00

📚 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.

05:00

🍽️ 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.

10:03

🔍 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.

Keywords

💡Olive Oil

Olive oil is a liquid fat obtained from olives, commonly used in cooking for its rich flavor and health benefits. In the video's context, it is a central topic of debate regarding its impact on health, specifically on endothelial cells and heart disease. Dr. Elstein's review of literature suggests that olive oil might cause damage to these cells, which align the arteries and are crucial for cardiovascular health.

💡Endothelial Cells

Endothelial cells are the thin layer of cells that line the interior surface of blood vessels and lymphatic vessels. They play a significant role in blood pressure control and overall cardiovascular health. The script discusses concerns that olive oil could damage these cells, potentially leading to negative health outcomes.

💡Flow-Mediated Dilation (FMD)

Flow-mediated dilation is a measure of how well an individual's arteries can dilate or widen, which is partially controlled by endothelial cells. In the video, FMD is used as an indicator to assess the impact of different types of fats, including olive oil, on arterial health. The script mentions studies showing varying effects of olive oil on FMD, which is a point of contention in the debate.

💡Mediterranean Diet

The Mediterranean diet is a dietary pattern inspired by the traditional cuisines of countries bordering the Mediterranean Sea, known for its emphasis on olive oil, fruits, vegetables, and whole grains. The video discusses Dr. Elstein's critique of the Mediterranean diet, suggesting it may contribute to cardiovascular disease, a point that is challenged by other evidence presented.

💡Dr. Elstein

Dr. Elstein is a physician mentioned in the script who has a history of advocating for a plant-based lifestyle. He has published a paper questioning the healthiness of oil, including olive oil, and his views are a central focus of the video's discussion on diet and cardiovascular health.

💡Meta-Analysis

A meta-analysis is a statistical technique used to combine and summarize the results of multiple studies to provide a more comprehensive understanding of a phenomenon. In the script, a meta-analysis of 28 randomized trials is cited to support the argument that olive oil improves flow-mediated dilation, contradicting Dr. Elstein's position.

💡Cardiovascular Disease

Cardiovascular disease refers to a class of diseases that involve the heart or blood vessels. The video script discusses the relationship between diet, specifically the Mediterranean diet and olive oil consumption, and the risk of developing cardiovascular disease.

💡Plant-Based Diet

A plant-based diet emphasizes foods derived from plant sources, such as vegetables, grains, nuts, and legumes, and typically excludes or limits animal products. Dr. Elstein is described as favoring this type of diet, and the video contrasts his views with the findings of studies on the Mediterranean diet.

💡Randomized Trial

A randomized trial is a type of scientific experiment where subjects are assigned to treatment or control groups by random selection. The script refers to a large-scale randomized human trial, the PREDIMED study, which is used to discuss the effects of the Mediterranean diet on cardiovascular health.

💡High-Risk Population

A high-risk population refers to a group of individuals who are more likely to develop a particular condition or disease due to various factors. In the context of the video, the participants of the PREDIMED study are described as high risk for cardiovascular disease, which influences the interpretation of the study's results.

💡Nutrition Made Simple

Nutrition Made Simple appears to be the source of the interview with Dr. Gil Carvalo, where Dr. Elstein's views on olive oil and the Mediterranean diet are discussed. It represents the platform where the debate on dietary fats and their health implications is presented and critiqued in the video.

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

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