Shownotes
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.
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Transcripts
I'm RIP Esselstyn and you're listening to the Plan Strong podcast.
RIP Esselstyn:A recent study published in the Journal of the American Heart association shows a win for oil free Plant Strong living.
RIP Esselstyn:And that, my Plant Strong cousins, is a big kale to the.
RIP Esselstyn:Yeah.
RIP Esselstyn:From us.
RIP Esselstyn:What exactly is the study and what did it show?
RIP Esselstyn:We're going to talk to one of the authors, Dr.
RIP Esselstyn:Monica Agrawal, and get all the details right after this message from Plan Strong.
RIP Esselstyn:As you all know better than anyone, it's no secret that we here at Plan Strong we're just not fans of added oil, including the most fabled and storied oil of them all, extra virgin olive oil.
RIP Esselstyn:It's highly processed at 120 calories per tablespoon, and it also is incredibly calorie dense.
RIP Esselstyn:In addition, you're going to hear today it may not be as heart healthy as it's touted to be.
RIP Esselstyn:In July of this year, the prestigious Journal of the American Heart association published a study entitled Recipe for Heart A Randomized Crossover Trial on Cardio Metabolic Effects of Extra Virgin Olive Oil Within a Whole Food Plant Based Vegan diet.
RIP Esselstyn:And the results were remarkable.
RIP Esselstyn: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.
RIP Esselstyn:And the oil free group also showed a more significant reduction in LDL cholesterol.
RIP Esselstyn:As a reminder, that's the lethal cholesterol which is crucial for reducing the risk of heart disease.
RIP Esselstyn:Well, of course I was curious to know more, so I invited one of the authors of the study, Dr.
RIP Esselstyn:Monica Agarwal, on the Plan Strong podcast, to give us all the details.
RIP Esselstyn:So let's slide right in right now.
RIP Esselstyn:Dr.
RIP Esselstyn:Monica Agarwal, welcome back to the Plan Strong podcast.
RIP Esselstyn:It's so fantastic to see your shining face and.
RIP Esselstyn:And the last time that I had you on you were episode 67.
RIP Esselstyn:Oh, wow.
Dr. Monica Agrawal:Baby, baby.
Dr. Monica Agrawal:When your podcast was, I think if.
RIP Esselstyn:I'm not mistaken, we were talking about this book, Body on Fire.
Dr. Monica Agrawal:Yay.
RIP Esselstyn:That had launched and how you basically, you know, were able to personally fight back all this bodily inflammation that you had going on in your life.
RIP Esselstyn:Right?
Dr. Monica Agrawal:Yeah.
Dr. Monica Agrawal:It's amazing to think, you know, it's been.
Dr. Monica Agrawal:My daughter is now almost 14 and this all started for me, I don't know, three months after she was born.
RIP Esselstyn:Yeah.
RIP Esselstyn:Yeah.
RIP Esselstyn: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.
RIP Esselstyn: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.
RIP Esselstyn:So for starters, you're an associate adjunct professor.
RIP Esselstyn:Professor at the Division of Cardiology at the University of Florida.
RIP Esselstyn:How long have you been doing that?
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:So if any of you out there are like that, me, you can relate.
Dr. Monica Agrawal:So I am.
Dr. Monica Agrawal:I've been.
Dr. Monica Agrawal:I was at the University of Florida in person for about six years, or six, six and a half years.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:So I still do research at the University of Florida.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:I was actually going to go for professor, and then I shifted to adjunct just because I do my research there still.
Dr. Monica Agrawal:I still teach medical students and fellows, but I'm not there on a daily basis.
Dr. Monica Agrawal:So that's why I shifted to adjunct.
Dr. Monica Agrawal:It's really just a terminology thing.
Dr. Monica Agrawal:So I have quite a.
Dr. Monica Agrawal:I do a lot of publications and I still publish under the University of Florida, so I'm on faculty there.
RIP Esselstyn:And how long have you had an affiliation with the University of Florida?
Dr. Monica Agrawal: nk I arrived from Malaysia in: Dr. Monica Agrawal:So.
Dr. Monica Agrawal:2016 to present.
RIP Esselstyn:Wow.
RIP Esselstyn:What were you doing in Malaysia?
Dr. Monica Agrawal:I was teaching medical school as a.
Dr. Monica Agrawal:As part of a program through Hopkins Hospital.
Dr. Monica Agrawal:So I was living in Baltimore before that.
Dr. Monica Agrawal:And.
Dr. Monica Agrawal:And I was offered an opportunity to teach medical school in Kuala Lumpur, Malaysia.
Dr. Monica Agrawal:So I took my entire family with three small children and moved to Kuala Lumpur.
Dr. Monica Agrawal:Go figure.
Dr. Monica Agrawal:Who does that crazy stuff you did?
Dr. Monica Agrawal:I know, me.
Dr. Monica Agrawal:And then I taught medical school.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And so I was offered a great opportunity at the University of Florida, and so I took it.
RIP Esselstyn:What is it about teaching medical students that is such a passion for you?
Dr. Monica Agrawal:You know, I've always loved to teach.
Dr. Monica Agrawal:I.
Dr. Monica Agrawal: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, you know, I was a struggling med student who didn't really know her way.
Dr. Monica Agrawal:I could have used a lot of mentorship.
Dr. Monica Agrawal:And the people who were my mentors were just have been lifelong friends and colleagues.
Dr. Monica Agrawal:And so I see the value in teaching and mentorship because if we don't teach the next generation, then who the heck is?
Dr. Monica Agrawal:Right?
Dr. Monica Agrawal:And, and physicians are tricky people.
Dr. Monica Agrawal:We're super busy, we're overloaded, there's so many demands on us.
Dr. Monica Agrawal:But if we have to make part of that priority of our future is teaching the people coming after us because especially in areas that they don't get very much education on, which is the nutrition, which is the area that both of us are so interested in.
Dr. Monica Agrawal:Nobody's teaching them nutrition and lifestyle and the impact of that.
Dr. Monica Agrawal:And while everybody knows it conceptually, nobody's actually really learning it, like really learning it.
Dr. Monica Agrawal:And so I see that as part of my role.
Dr. Monica Agrawal:And you know, now in the past, in the current and in the future are.
RIP Esselstyn:So as part of what you are teaching these medical students, is it nutrition?
RIP Esselstyn:Is it whole food plant based?
RIP Esselstyn:Are they?
RIP Esselstyn:And if so, are they receptive to hearing it?
Dr. Monica Agrawal:Yeah.
Dr. Monica Agrawal:So I teach a lot of the nutrition programming.
Dr. Monica Agrawal:I did it at the University of Florida.
Dr. Monica Agrawal:I do it at the University of Central Florida.
Dr. Monica Agrawal:I have fellows, residents and medical students from both of those places that come around and rotate with me.
Dr. Monica Agrawal:I have Advent Health family physicians that rotate with me.
Dr. Monica Agrawal:So and what do I teach them?
Dr. Monica Agrawal:I teach them all sorts of nutrition, I teach them about lifestyle.
Dr. Monica Agrawal:I don't just focus on nutrition.
Dr. Monica Agrawal:I do a lot of lifestyle teaching, social connection, empathy training.
Dr. Monica Agrawal:In terms of what I teach them nutrition wise, I teach them what the data shows.
Dr. Monica Agrawal:So I show them the data and I let them decide.
Dr. Monica Agrawal:And you know, we all know that the data supports plant forward eating and so we educate them that the foundation of every meal should be planned forward.
RIP Esselstyn:So you mentioned Advent Health there you're also a preventive cardiologist and lipid lipid specialist there.
RIP Esselstyn:Is that, is that online?
RIP Esselstyn:Is there a location you go to with Advent Health?
RIP Esselstyn:How does that.
Dr. Monica Agrawal:Yeah, I'm based in Orlando, so I see patients in Orlando.
Dr. Monica Agrawal:So I'm a board certified lipidologist or lipid specialist.
Dr. Monica Agrawal:So I deal with patients who have very complex lipid disorders.
Dr. Monica Agrawal: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 want a second opinion.
Dr. Monica Agrawal:Some of them come from your dad, which is always fun when se Sends me a patient.
Dr. Monica Agrawal:And 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.
RIP Esselstyn:Hmm.
RIP Esselstyn:So recently you were.
RIP Esselstyn:Were you appointed or elected?
RIP Esselstyn:How did that work?
RIP Esselstyn:The Nutrition Chair at the American College of Cardiology.
Dr. Monica Agrawal:Yes.
Dr. Monica Agrawal:So the American College of Cardiology is our big society of cardiologists that we all look to for guidance, guideline management, our education.
Dr. Monica Agrawal:So much of it comes from the American College of Cardiology.
Dr. Monica Agrawal:And so recently I was elected, nominated as.
Dr. Monica Agrawal:To be the Nutrition Chair, which is exciting.
Dr. Monica Agrawal:So, you know, I been on that committee for several years, and some of my dearest friends are on there.
Dr. Monica Agrawal:People like Kim Williams, Neil Barnard, Rob Osfeld, you know, friends, friends of all of ours are all on our committee.
Dr. Monica Agrawal:And.
Dr. Monica Agrawal:Yeah.
Dr. Monica Agrawal:And so this last year, or actually this summer, I was nominated to be the chair.
RIP Esselstyn:That's great.
RIP Esselstyn: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.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:Starting nutrition.
RIP Esselstyn:That must be pretty darn exciting.
Dr. Monica Agrawal:It's very exciting.
Dr. Monica Agrawal:It's.
Dr. Monica Agrawal:It's hard work.
Dr. Monica Agrawal: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, Neil's on the.
Dr. Monica Agrawal:Neil's on the group and Darius Mazaffarian, and they're really interested in policy.
Dr. Monica Agrawal:And so having.
Dr. Monica Agrawal:Moving forward, medical education and medical nutrition policy is an area of focus that I have, Steve DeVries, who's a great friend and is really involved in medical education.
Dr. Monica Agrawal:So we've just subappointed him as the new education person.
Dr. Monica Agrawal:So.
Dr. Monica Agrawal:Education chair.
Dr. Monica Agrawal:So he's going to help me build education in medical schools, residencies, fellowships.
Dr. Monica Agrawal:And he's done such a great job with his Gables Institute and really admire his work.
Dr. Monica Agrawal:And then I have a.
Dr. Monica Agrawal:I've appointed a sub.
Dr. Monica Agrawal:Sub chair for fellows in training to sort of then help with the.
Dr. Monica Agrawal:Because I'm a strong believer, as you noted, I'm a strong believer in mentorship.
Dr. Monica Agrawal:And so then building up that new cohort of early, early faculty is a great joy.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:I think.
Dr. Monica Agrawal: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 non believers and there's so Much misinformation out there.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:Many people are getting their information from TikTok videos and social Instagram and, and they think that this is, this is correct knowledge.
Dr. Monica Agrawal:And so we're fighting against that social media component.
Dr. Monica Agrawal: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 in nutrition.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And it's there many things I'm terrible at that I learned from other people.
Dr. Monica Agrawal:So, you know, everything is supposed is meant to be supportive out of love, out of all of us growing together.
RIP Esselstyn:All right, so Monica, let's dive into this recently published article and it's called A Recipe for Heart Health.
RIP Esselstyn:A randomized crossover trial on cardio metabolic effects of extra virgin olive oil within a whole food plant based vegan diet.
Dr. Monica Agrawal:Mouthful.
RIP Esselstyn:No, it really is.
RIP Esselstyn:But let's just so that the audience can understand.
RIP Esselstyn:I want to pick it apart a little bit.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:So a randomized.
RIP Esselstyn:What does that mean?
RIP Esselstyn:Randomized.
RIP Esselstyn:What does that word mean?
Dr. Monica Agrawal:So you don't know when you use the word randomized?
Dr. Monica Agrawal:It's very important to us when we do clinical trials to randomize our people.
Dr. Monica Agrawal:So you don't know if you're going to get the.
Dr. Monica Agrawal:So in a medication trial, for instance, randomized would mean either you get the medicine or you might get the placebo.
Dr. Monica Agrawal:And it's important because people don't realize that so much of people feeling better is actually placebo effect.
Dr. Monica Agrawal:And so when you have a placebo arm, then you're avoiding or reducing that.
Dr. Monica Agrawal:Obviously in a nutrition trial, we don't really do a placebo effect.
Dr. Monica Agrawal:We don't have a placebo in the way you're thinking.
Dr. Monica Agrawal: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.
RIP Esselstyn:And then crossover.
RIP Esselstyn:What does the word crossover mean?
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:We have different gut bugs, we have different environmental factors.
Dr. Monica Agrawal:And so all of these stressors and all these things impact you versus me.
Dr. Monica Agrawal:And so how do I know that your LDL may be 100 and mine might be 70.
Dr. Monica Agrawal:Not to say I have no idea what your LDL is, just so we're clear.
Dr. Monica Agrawal:But yours might be that and mine might be 70.
Dr. Monica Agrawal:And then when we give you the food, then the impact on you might be different than the impact on me.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so it's really important in nutrition studies in particular to use each person as their own control.
Dr. Monica Agrawal:So in other words, you start when you start on your western diet and we put them into a nutrition intervention, then they go through and we compare their data to themselves.
RIP Esselstyn:Got it, Got it.
RIP Esselstyn:Okay, so how did this come to being?
RIP Esselstyn:Was this your brainchild, this study?
RIP Esselstyn:And why, why do this study?
Dr. Monica Agrawal:It was my brainchild because I think so many years I've, you know, I'm always somebody who likes to ask questions.
Dr. Monica Agrawal: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 planned forward eating is optimal for, for patients with heart disease.
Dr. Monica Agrawal:There's, there should be no debate about this.
Dr. Monica Agrawal:No matter if you, the, the keto people are wrong, the Paleo people are wrong.
Dr. Monica Agrawal:It's a plan for diet.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And it's gotten so much hype.
Dr. Monica Agrawal:We've had huge trials, the PREDIMED study, 7,000 patients, we had the Leon heart study.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And so, and there's all these pieces in that diet that I don't really fully understand.
Dr. Monica Agrawal:And so then there's a plant forward diet.
Dr. Monica Agrawal: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?
Dr. Monica Agrawal:Or is it that any, is any plant forward diet good for you?
Dr. Monica Agrawal:And if you add a little olive oil and a little bit of fish or whatever, does that matter?
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And as you may know, in a Mediterranean diet, there's often a liberal use of extra virgin olive oil.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And so I wanted to understand specifically, does the olive oil itself, like, are there pieces of this diet that make it better?
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:If you just eat anything else and you just add this piece, you're going to make people better?
Dr. Monica Agrawal:So that's something I've always wanted to understand.
Dr. Monica Agrawal:So I decided to run a study to look specifically at extra virgin olive oil.
Dr. Monica Agrawal:And so that's where that came from.
RIP Esselstyn:Well, I think it's absolutely brilliant what you were able to do.
RIP Esselstyn:And you started all this in, like, 20, 21, probably in the middle of COVID if I'm not mistaken.
Dr. Monica Agrawal:Oh, yeah, it was super hard.
Dr. Monica Agrawal:I mean, it was super hard to do this study.
Dr. Monica Agrawal:It was super hard because.
Dr. Monica Agrawal:Exactly.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:We were literally doing this in the middle of an epidemic.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so it took longer to recruit, for sure.
Dr. Monica Agrawal:But it was very interesting.
Dr. Monica Agrawal:People.
Dr. Monica Agrawal:People love this study.
Dr. Monica Agrawal:You know, 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.
RIP Esselstyn:Yeah.
RIP Esselstyn:Can you.
RIP Esselstyn:Can you let us know?
RIP Esselstyn:I've.
RIP Esselstyn:I've read it, and it's super impressive.
RIP Esselstyn:But can you let the listener know about the kind of.
RIP Esselstyn:The methods, the cohort, how many people were in the study, their.
RIP Esselstyn:Their ages?
RIP Esselstyn:Male, female, all that jazz?
Dr. Monica Agrawal:Sure, sure.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:Most people were women.
Dr. Monica Agrawal:And which is also very common in studies, especially nutrition studies.
Dr. Monica Agrawal:We looked at patients who had at least borderline risk of heart disease.
Dr. Monica Agrawal:So we have a risk calculator that we as cardiologists use.
Dr. Monica Agrawal:We can put in your blood pressures or your cholesterol and your age, and then we can.
Dr. Monica Agrawal:It spits out a risk profile of low, borderline.
Dr. Monica Agrawal:And so we wanted people who were at.
Dr. Monica Agrawal:Had some risk features of heart disease, but we also.
Dr. Monica Agrawal:But we didn't include people who actually had known heart disease.
Dr. Monica Agrawal:And that.
Dr. Monica Agrawal:That was.
Dr. Monica Agrawal:So we had some criteria for that.
Dr. Monica Agrawal: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 with heart disease will be on statins.
Dr. Monica Agrawal:And so I wanted to use a cohort of people that maybe weren't on medications or weren't on statins in particular.
Dr. Monica Agrawal:So I took 40 people and I put them through a randomized crossover design study.
Dr. Monica Agrawal:So we took 20 people and we put 20 people that were randomized to high olive oil and I'll tell you what that means in a minute.
Dr. Monica Agrawal:And they would have, would have to eat that way.
Dr. Monica Agrawal:So they had to eat 100% plant based diet with high olive oil for four weeks.
Dr. Monica Agrawal:Then we washed it out and then we put that same group of people on 100% plant based diet with low olive oil.
RIP Esselstyn:When you say a one week washout, what exactly does that mean?
Dr. Monica Agrawal: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.
Dr. Monica Agrawal: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 it's hard to then assess the second part of the intervention because they've already come down to here.
Dr. Monica Agrawal:If you start here and you change just a little bit, you might only see this much change.
Dr. Monica Agrawal:Does that make sense?
RIP Esselstyn:Yeah.
Dr. Monica Agrawal:So with that, and so with that, you try to wash them out.
Dr. Monica Agrawal:So you hope that they kind of go back up so that you can still see the notable impact.
Dr. Monica Agrawal:But you'll see in our data in particular, we struggle with crossover issues because people didn't wash out completely.
Dr. Monica Agrawal:And this is often a struggle in nutrition studies because who wants to go back to those old unhealthy habits?
Dr. Monica Agrawal:And so what happens often is people cross over, they don't fully wash out, and then you see a less impact in the second part of the second part of the intervention.
Dr. Monica Agrawal:And we, we definitely suffered from that.
RIP Esselstyn:During the study, I would imagine.
RIP Esselstyn:I mean, four weeks of eating whole food, plant based, you know, low oil or, or, or even the high olive oil, high, the high amount, I would imagine.
RIP Esselstyn:Wow, you probably, they probably felt so much better.
Dr. Monica Agrawal:Well, that's exactly it.
Dr. Monica Agrawal:I mean, people were so happy in the study.
Dr. Monica Agrawal:And remember, we added this education and community component so that you're in this group of people of 8 to 10 people, which was, each cohort was about 8 to 10 people that you meet every week.
Dr. Monica Agrawal:You're on zoom together.
Dr. Monica Agrawal:You're literally during some of the classes, people would pull up, they'd be like, what do I do with these oats?
Dr. Monica Agrawal:You know, and then everybody else weighs in.
Dr. Monica Agrawal:Like it was this lovely community.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And these were people of different demographics, social, economic status, different ethnic groups.
Dr. Monica Agrawal:And it was just so cool.
Dr. Monica Agrawal:And my favorite part actually of the intervention is how much community and connection we created.
Dr. Monica Agrawal: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.
RIP Esselstyn:Yeah, yeah.
RIP Esselstyn:Okay, so what was the, the difference in the amount of fat in the two groups?
Dr. Monica Agrawal:Well, so the high olive oil.
Dr. Monica Agrawal:So remember, we put everybody on 100% plant based diet.
Dr. Monica Agrawal:They all were on a western diet and we put them on 100% plant based diet.
Dr. Monica Agrawal:So, you know, a huge difference already.
Dr. Monica Agrawal:But we were worried about the fat and because many people will say, well, you just cut their fat.
Dr. Monica Agrawal:That's why you saw an improvement in their.
Dr. Monica Agrawal:Our primary endpoint, which was LDL reduction.
Dr. Monica Agrawal:Now let's step back a little.
Dr. Monica Agrawal:What is ldl?
Dr. Monica Agrawal:LDL is the bad cholesterol.
Dr. Monica Agrawal:It's responsible for pulling atheroma or plaque inside the blood vessels.
Dr. Monica Agrawal:We know that from the cholesterol trialist 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%.
Dr. Monica Agrawal:So it's like a surrogate endpoint.
Dr. Monica Agrawal:It helps you.
Dr. Monica Agrawal:It's sort of an outcomes sort of.
Dr. Monica Agrawal:It can be extrapolated to outcomes.
Dr. Monica Agrawal:So we really like an LDL reduction, especially when we talk about statins.
Dr. Monica Agrawal:Remember we talk about a 30 to 50% reduction with a moderate intensity statin.
Dr. Monica Agrawal:You know, we use those percentages.
Dr. Monica Agrawal:So using an LDL endpoint was important.
Dr. Monica Agrawal:So we gave patients 100% plant based diet.
Dr. Monica Agrawal:So this is.
Dr. Monica Agrawal:No, you know, these weren't.
Dr. Monica Agrawal:People were not eating processed foods.
Dr. Monica Agrawal:I'm sure they were some dietary discretions.
Dr. Monica Agrawal:But overall they were eating plant.
Dr. Monica Agrawal:We provided them with oil, we gave them gift cards every week so that, that they could buy those plant based foods if they were expensive.
Dr. Monica Agrawal:And then we put again, that high olive oil would eat about 4 tablespoons of oil per day.
Dr. Monica Agrawal:And that's a lot.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:In fact, that's considered very common in the Mediterranean area.
Dr. Monica Agrawal:That's why we picked that number, because it's been used in other studies.
Dr. Monica Agrawal:Whereas the American diet is more.
Dr. Monica Agrawal:Is much less oil in that raw form.
Dr. Monica Agrawal:I should clarify.
Dr. Monica Agrawal:And we used.
Dr. Monica Agrawal:The other low oil cohort was less than a teaspoon.
Dr. Monica Agrawal:So when you think about that, this oil, we wanted them to drink it, we wanted it raw, we wanted it uncooked.
Dr. Monica Agrawal:And so some people struggled with how to get that oil into their system, for sure.
RIP Esselstyn:Oh, I would imagine.
RIP Esselstyn:I mean, I think just to put it into perspective, my.
RIP Esselstyn:I'd say most Americans are probably getting three to five tablespoons of oil a day, but including in their, their package, their box, their canned foods.
RIP Esselstyn:And then if they're having a salad or stir fry or whatever.
RIP Esselstyn:So interesting.
RIP Esselstyn:And.
RIP Esselstyn:And also so uncooked in its raw form.
RIP Esselstyn:And you said the high group was getting how many tablespoons a day?
Dr. Monica Agrawal:4.
RIP Esselstyn:4.
RIP Esselstyn:4.
RIP Esselstyn:So 4 times 120.
RIP Esselstyn:You know, do the math on that.
RIP Esselstyn:That's how many calories, Monica?
RIP Esselstyn:520.
RIP Esselstyn:Right.
Dr. Monica Agrawal:I'm the worst at math.
RIP Esselstyn:Well, it's four.
RIP Esselstyn:It's 520 calories.
RIP Esselstyn:I mean, that's almost what, 25%, I would imagine, of their daily caloric intake.
Dr. Monica Agrawal:And that's what makes it tricky, though, too.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:Because if we're trying to do a study where we don't adjust fat significantly.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:The flavonoids, the phytonutrients inside olive oil.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And so I wanted actually to not have such a difference in fat.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:But, you know, when we looked at weight loss, interestingly, it wasn't that much difference.
Dr. Monica Agrawal:I think it was less than a kilo per.
Dr. Monica Agrawal:In both group.
Dr. Monica Agrawal:Between the groups.
Dr. Monica Agrawal:So we, we were actually fairly happy that we got even in the low olive oil group.
Dr. Monica Agrawal:We had the fat intake at about 32% and out in the high olive oil, it was about 42 to 45.
Dr. Monica Agrawal:I, I haven't looked at the study in a few weeks, so it may not be the exact number.
Dr. Monica Agrawal:Don't, don't quote me on it.
Dr. Monica Agrawal:If I said 42 and it was 45.
Dr. Monica Agrawal:But somewhere about those numbers.
Dr. Monica Agrawal:And so when you.
Dr. Monica Agrawal:So both of those arguably are not low fat.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so that was important to us.
Dr. Monica Agrawal:So I wanted to, what I, when we get criticism about this, like.
Dr. Monica Agrawal:Well, you have a significant fat disparity.
Dr. Monica Agrawal:Yes.
Dr. Monica Agrawal:But both of them are fairly high fat diets and the weight difference wasn't that significant.
Dr. Monica Agrawal:And so what I think is important, 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.
RIP Esselstyn:Yeah.
RIP Esselstyn:It was 48.
RIP Esselstyn:Thank you.
RIP Esselstyn:And it was 32 on the low group.
RIP Esselstyn:But how, how are you able to come up with that?
RIP Esselstyn:Did you actually.
RIP Esselstyn:Were they keeping a food log of everything they were eating?
RIP Esselstyn:Okay.
Dr. Monica Agrawal:Yep.
Dr. Monica Agrawal:We had very meticulous.
Dr. Monica Agrawal:So my PhD student who's now a full time PhD, now, Dr.
Dr. Monica Agrawal:Andrea Krennic, it's nice to call her doctor.
Dr. Monica Agrawal:She's actually moved on to work in Chris Gardner's lab in, at Stanford, which is wonderful.
Dr. Monica Agrawal:And she was, she was very involved in the study and hosted.
Dr. Monica Agrawal:She actually was the nutritionist who also ran the programming and she did a meticulous accounting of what everybody was eating.
RIP Esselstyn:Right.
RIP Esselstyn:Well, you, and I'm sure you're aware that, you know, my, my father with his patients and Dean Ornish and some others, they actually like, you know, they consider a low fat about 10 to 15% of calories.
Dr. Monica Agrawal:That's exactly right.
Dr. Monica Agrawal:And so.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so that's, that's what I think is one of the pieces that makes this study so interesting is that they didn't have a 10%.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so.
Dr. Monica Agrawal:Because then that's what a lot of people criticize when you eat a low fat diet and.
Dr. Monica Agrawal:Well, of course it's low fat.
Dr. Monica Agrawal:You know, that's why you made an impact.
Dr. Monica Agrawal:But I wasn't asking that question.
Dr. Monica Agrawal:I was trying to specifically ask is the olive oil itself so great.
RIP Esselstyn:Yeah.
RIP Esselstyn: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?
Dr. Monica Agrawal:So first of all, we looked at a lot of clinical endpoints and markers.
Dr. Monica Agrawal:Rather, we specifically was driven by ldl.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:Which is what we talked about, but we looked at hdl.
Dr. Monica Agrawal:We looked at triglycerides, we looked at sugars, we looked at something called lipoprotein, little A, APO B.
Dr. Monica Agrawal:So for people who are sort of science nerds like me, fructosamine, glucose, HSCRP and tmao.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:So in other words, if you drop, if you were on an extra, 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.
Dr. Monica Agrawal:That's huge.
Dr. Monica Agrawal:And then if you were in the low, in the high olive oil group, you only had about a 10 to 15 point drop.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:So there's a significant difference in the drop in LDL when you go low olive oil to high.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And so we saw a more significant reduction.
Dr. Monica Agrawal:They are also higher fiber.
Dr. Monica Agrawal:We actually look back at the amount of fiber intake.
Dr. Monica Agrawal:The people that were eating the low olive oil group had an excess amount of fiber in their diet, which was amazing.
Dr. Monica Agrawal:Which, remember, we all know that fiber reduces ldl.
RIP Esselstyn: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.
RIP Esselstyn:It was only 10 points.
RIP Esselstyn:I would have thought it would have been even more than that.
RIP Esselstyn: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.
RIP Esselstyn:I just see olive oil is the equivalent of white sugar in the fat world.
RIP Esselstyn:I don't think that there's really hardly anything beneficial about it.
RIP Esselstyn:It's 14 saturated fat.
RIP Esselstyn:And maybe, and we know that saturated fat raises cholesterol levels and LDL.
RIP Esselstyn:And so if people are consuming on average 4 added tablespoons of olive oil a day, I mean, I'm trying to Think what, what's the protective substances mechanisms in that olive oil that people are just kind of chirping about right now?
RIP Esselstyn:Oh, I saw this study that, you know, was three years long and people that were eating olive oil did this and this.
RIP Esselstyn: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.
Dr. Monica Agrawal:Yeah, I think the thing though that, you know, there's not a more significant drop.
Dr. Monica Agrawal:I mean, you have to remember that people were eating this badly and then they, you know, they, they both went plant based.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so the plant based eating is what we should be emphasizing to all of our patients.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:So like, there's no question that both groups, high and low olive oil did, had significant improvement when they moved away from the standard diet to a plant based diet.
Dr. Monica Agrawal:So we need everybody to eat plant based.
Dr. Monica Agrawal:That's not just you or maybe you and only because you have heart disease, it's everybody.
Dr. Monica Agrawal:And then on top of that, maybe oil, and specifically extra virgin olive oil is not so great.
Dr. Monica Agrawal:And that's not something we should be adding for our health.
Dr. Monica Agrawal: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 not even olive oil, but oil if they feel like they need it, but less oil is better.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:Maybe it isn't so great like.
Dr. Monica Agrawal:And so 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.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:Because these are people that are still eating fatty food, but they're eating it in whole form.
Dr. Monica Agrawal:They're eating it in whole form and that's the key.
Dr. Monica Agrawal:So eat those whole foods.
Dr. Monica Agrawal:You know, you don't have to cut your calories down.
Dr. Monica Agrawal:That's why so many of us don't say, yeah, count your calories or adjust this.
Dr. Monica Agrawal:We just want you to eat those whole foods.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:And to me, truthfully, I say that for all Oils.
Dr. Monica Agrawal:And so, you know, all of the oils need to be reduced in amount because it's a concentrated form.
Dr. Monica Agrawal:So eat five olives, you know, eat 20 olives, you still won't get what you're getting from the 4 tablespoons of olive oil.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so it puts things into perspective that whole foods, plant based, this is optimal eating.
Dr. Monica Agrawal:There should be no debate about that.
Dr. Monica Agrawal:And then on top of that, please don't add the oil for your health.
RIP Esselstyn:Yeah, yeah.
RIP Esselstyn:So what are, I mean, first, how exciting that you were able to dream this up, get the funding, make it happen.
RIP Esselstyn:And we're.
RIP Esselstyn:Now you're what, three and a half, four years later, right?
Dr. Monica Agrawal:Yeah, it was a long time before we got it published.
RIP Esselstyn:Yeah.
Dr. Monica Agrawal:But it's so cool.
Dr. Monica Agrawal:The journal American Heart association is considered one of the best journals in the world for cardiology.
Dr. Monica Agrawal:And we were proud that they felt it was despite its negatives.
Dr. Monica Agrawal:I mean, again, anybody who's a scientist who's listening to this is going to say, well, these are the negatives.
Dr. Monica Agrawal:I agree there were definitely issues with our crossover design, the length of the study.
Dr. Monica Agrawal:We needed a longer washout.
Dr. Monica Agrawal:I agree with all the more finite measurement of fat intake in the future for next studies, but nobody can discount what we found.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:But I think that there's no question that there's a trend here that needs to be evaluated, monitored, and we should be eating oils with caution.
RIP Esselstyn:Yeah.
RIP Esselstyn: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?
Dr. Monica Agrawal:I think so.
Dr. Monica Agrawal:I mean, you know, I'm, it's definitely research is a labor of love for sure, but it is pretty impactful stuff.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And you know, we've, we, we, we debunked something or at least started the conversation about something that people have automatically assumed is good.
Dr. Monica Agrawal:And so we've just sort of said to the question, really, is it, is it that good?
Dr. Monica Agrawal:You know, and so people haven't really asked that question.
Dr. Monica Agrawal:So we're proud to be one of the first people who've ever asked that question.
Dr. Monica Agrawal:So do I want to run the study bigger and better?
Dr. Monica Agrawal:Heck, yeah.
Dr. Monica Agrawal:Do I have the funding for it?
Dr. Monica Agrawal:No.
Dr. Monica Agrawal:And unfortunately, it's very hard to get funding for nutrition studies.
Dr. Monica Agrawal:And so, so we definitely struggle with that in general.
Dr. Monica Agrawal:And everyone in the, in the world struggles with funding when it comes to nutrition because it is challenging Work.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:So that's how pharmaceuticals work.
Dr. Monica Agrawal:But unfortunately, because it's.
Dr. Monica Agrawal:Unfortunately, it's just nutrition.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:Just eat better.
Dr. Monica Agrawal:But there's nothing to market there.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:And if this is something that you don't want to share, I completely understand.
RIP Esselstyn:But like, what was the budget for this study?
Dr. Monica Agrawal:I would have to check.
Dr. Monica Agrawal:Exactly.
Dr. Monica Agrawal:But it was over a hundred thousand, maybe 150.
RIP Esselstyn:Oh, that doesn't actually.
RIP Esselstyn:That doesn't sound bad.
Dr. Monica Agrawal:Yeah, I mean, we did it pretty bare bones, but remember, we only had 40 people.
RIP Esselstyn:Yeah, yeah, yeah.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so if I were to do it again, I would want to do several hundred people.
Dr. Monica Agrawal:I would want to do a longer washout period.
Dr. Monica Agrawal:I would have.
Dr. Monica Agrawal:Like to have more control of fat intake.
Dr. Monica Agrawal:And that's always a little bit tricky, which would require dietitians to really help us in on, you know, almost within each individual.
Dr. Monica Agrawal:So that would take a little bit more work, but all doable.
Dr. Monica Agrawal:But, you know, is cost.
Dr. Monica Agrawal:It's expensive.
RIP Esselstyn:Yeah.
RIP Esselstyn:If you don't mind, I'd love to talk to you right now specifically about olive oil.
RIP Esselstyn:And I have some questions for you.
RIP Esselstyn:And so as.
RIP Esselstyn:As you heard me say earlier, I just think it's empty calories.
RIP Esselstyn:I just literally think it's the equivalent of what white sugar is in the carbohydrate world.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:Is in the fat world.
RIP Esselstyn:Like you said, it's the most concentrated source of calories on the planet.
RIP Esselstyn:It's really, for the most part, got no fiber, no vitamins, minerals, phytonutrients.
RIP Esselstyn:Now what.
RIP Esselstyn:When I ask people why, what is it about olive oil that you find healthy?
RIP Esselstyn:They typically say two things.
RIP Esselstyn:They say it's loaded with polyphenols and it's got antioxidants.
RIP Esselstyn:I'm going to put you on the spot here.
RIP Esselstyn:Do you have any idea how many polyphenols are in a tablespoon of olive oil?
Dr. Monica Agrawal:So it's interesting.
Dr. Monica Agrawal:So I think that there's.
Dr. Monica Agrawal:So first of all, olive oil.
Dr. Monica Agrawal:Olive oil and olive oil, three different olive oils are totally different.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:In terms of how.
Dr. Monica Agrawal:What the polyphenol content is.
Dr. Monica Agrawal:Is different in all of those.
Dr. Monica Agrawal:So that's one thing in this study, because people have asked, we used a moderate level.
Dr. Monica Agrawal:A poly.
Dr. Monica Agrawal:Moderate level polyphenol content.
Dr. Monica Agrawal:And so because we wanted to use something that people get over the counter.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:We didn't want to get something super hard to get etc.
Dr. Monica Agrawal:So with that in mind, I don't know what to do with that information.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:But, 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.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so that's the problem with so many of the designs.
Dr. Monica Agrawal:And so when people say these are high in antioxidants and polyphenols, I'm like, oh, okay, maybe because it's hard to know also how much that translates into actually each person like what's bioavailable and what's not.
Dr. Monica Agrawal:So I do believe that because we know that olives have benefits, that there is some benefit in oils or in olive oil.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:Now in this new study that we write, we would put in new Alzheimer's criteria, would put in other criteria to show that maybe the oil in all these decision and these other disease states was also not beneficial.
Dr. Monica Agrawal:And I would love to add those components to it.
Dr. Monica Agrawal:But for now, and you know, I know you're putting 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.
Dr. Monica Agrawal:The concentrated form maybe has some nutrient quality.
Dr. Monica Agrawal:But is it impactful in heart disease?
Dr. Monica Agrawal:I would say no.
RIP Esselstyn:Yeah, well, and I think you said this earlier, I mean we want everybody to eat more whole plant based foods.
RIP Esselstyn: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.
RIP Esselstyn:Right.
Dr. Monica Agrawal:Like this would be a no brainer, Eat the olives.
Dr. Monica Agrawal:If you want olive oil, eat olives.
RIP Esselstyn:So let me, let me give you an example because I think that, you know, I've done, I did a little research.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:And I found it to be absolutely mind blowing when people say it's loaded with polyphenols.
RIP Esselstyn:So obviously different olive oils will vary depending upon where it's from and all that stuff.
RIP Esselstyn: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.
RIP Esselstyn:Okay.
RIP Esselstyn:Now you could have eight olives.
RIP Esselstyn:Eight olives will give you the same amount and that's only 50 calories.
RIP Esselstyn:So 50 versus 400 to give you the exact same amount of polyphenol.
RIP Esselstyn:So.
Dr. Monica Agrawal:Plus the fiber intake.
Dr. Monica Agrawal:Right, right.
Dr. Monica Agrawal:You know, think about the fiber and all the other new.
Dr. Monica Agrawal:I mean it.
Dr. Monica Agrawal:Yeah.
RIP Esselstyn:So, so anyway, I find that to be like, okay, people are doing it.
RIP Esselstyn:It has nothing except polyphenols.
RIP Esselstyn:Okay.
RIP Esselstyn:But minuscule.
RIP Esselstyn:The other thing people say is, well, it's got antioxidant, antioxidants.
RIP Esselstyn:Well, it really doesn't.
RIP Esselstyn:So you look it up.
RIP Esselstyn:It's got zero vitamin A.
RIP Esselstyn:Well, I mean there's four basically things that make up antioxidants for the most part.
RIP Esselstyn:AC E and selenium.
RIP Esselstyn:It's got zero vitamin A, it's got zero vitamin C.
RIP Esselstyn:It's got zero selenium.
RIP Esselstyn:And guess what?
RIP Esselstyn:It's got trace amounts of vitamin E.
RIP Esselstyn:And I did the math because I found it to be so fascinating.
RIP Esselstyn:So guess how many milligrams of vitamin E are in one tablespoon of olive oil?
Dr. Monica Agrawal:Oh, boy.
RIP Esselstyn:It's got 1.9 milligrams.
Dr. Monica Agrawal:Wow.
RIP Esselstyn:So the two things, polyphenols and antioxidants.
RIP Esselstyn:But the only antioxidants that's there is vitamin E.
RIP Esselstyn: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.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:But separately, olive oil.
Dr. Monica Agrawal:Yeah.
Dr. Monica Agrawal:You know, has some polyphenols.
Dr. Monica Agrawal:We can't ignore that.
Dr. Monica Agrawal:But relative to what you can get from eating plant based foods, like it's.
Dr. Monica Agrawal:That should be the conversation, I think.
Dr. Monica Agrawal:And I think that people are more responsive to that conversation when you see it that way.
Dr. Monica Agrawal:And the only other, the only other thing I was going to say is we should write this up in like a little blog.
Dr. Monica Agrawal:You know, we can put in the, we can put in the study, but then we can put in these calculations.
Dr. Monica Agrawal:You put in and then put it out there because people should see those Numbers.
Dr. Monica Agrawal:And I, I thought that was really great that you put those numbers together.
RIP Esselstyn:Yeah, no, thank you.
RIP Esselstyn:And I just, yeah, I, I, I, I just find it to be such a, a mind melt.
RIP Esselstyn:Yeah.
RIP Esselstyn:People take a little bit of polyphenols and all of a sudden it makes it into a health food.
Dr. Monica Agrawal:Right.
RIP Esselstyn:When it is like we've talked about, it's just, it's crazy.
Dr. Monica Agrawal:So take away the right thing.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so, you know, take away the right thing which is eat more plant based, eat lots and lots of whole foods.
Dr. Monica Agrawal:Don't focus on eating these concentrated forms of anything because they're not usually going to be as good as their original.
Dr. Monica Agrawal:Just eat the original.
Dr. Monica Agrawal:I mean that's what we need.
Dr. Monica Agrawal:We need that.
Dr. Monica Agrawal:We're the original vegetable eaters.
Dr. Monica Agrawal:The original gangsters.
Dr. Monica Agrawal:Were the OVs original vegetables.
RIP Esselstyn:Yeah.
RIP Esselstyn:If you don't mind, I have a couple questions for you from, from our plan.
RIP Esselstyn:Strong audience because they knew I was going to be talking to you today.
RIP Esselstyn:So this one comes from Pamela and she says thank you so much for this article, Dr.
RIP Esselstyn:Aggarwal.
RIP Esselstyn: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.
RIP Esselstyn: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.
RIP Esselstyn:So I'm hoping that in 15 years, the 15 years since then, there might be a, there might be more ability to answer that question.
Dr. Monica Agrawal:Yeah, yeah, it's a great question.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:You know, I think that, you know, if you look at the qualitative data and people that are eating these low fat diets, their brain functions great.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so, but do I have a study to sort of show that specifically about olive oil?
Dr. Monica Agrawal:I don't.
Dr. Monica Agrawal:I think people do have this obsession though with you know, fat and like needing a certain amount.
Dr. Monica Agrawal:And people often say to my, 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.
Dr. Monica Agrawal:Like okay, hold the phone.
Dr. Monica Agrawal:So when you're, you know, you need a little bit of cholesterol to build cell membranes.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:But your LDL when you're born is 40 to 50.
Dr. Monica Agrawal:And so you don't, if you can build, bake a baby into an adult with the LDL of 40 to 50.
Dr. Monica Agrawal:Why do we need any more than that at any other time?
RIP Esselstyn:Yeah, the other thing that I would can add on to 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.
RIP Esselstyn:Right.
RIP Esselstyn:I mean these people were getting 32% of their calories from fat.
RIP Esselstyn:So there's fat in everything.
Dr. Monica Agrawal:Right, Right.
Dr. Monica Agrawal:And so I think we focus so much that we're going to lose brain function if we cut back too much on, on oils.
Dr. Monica Agrawal:But no, I mean you, if you eat the whole foods, you're going to be just fine.
Dr. Monica Agrawal:Like just eat the whole foods, your brain's going to develop fine, everything's gonna be good and fine.
Dr. Monica Agrawal:Well, I have the clear scientific data that I can do the same study on an Alzheimer's group.
Dr. Monica Agrawal:It would be fun.
RIP Esselstyn:Yeah.
RIP Esselstyn:Dr.
RIP Esselstyn:Aggarwal, I am oil free.
RIP Esselstyn:But many of my oil free plant based friends are confused about olive oil because Dr.
RIP Esselstyn:Kim Williams and Dr.
RIP Esselstyn:Joel Khan both say olive oil is good due to a recent study that they read about it.
RIP Esselstyn:Dr.
RIP Esselstyn:Williams says a small amount is beneficial for non overweight individuals due to the polyphenol content in olive oil.
Dr. Monica Agrawal:Yeah, I know exactly what study is talking about.
Dr. Monica Agrawal:Kim and I have talked about that study and it's interesting.
Dr. Monica Agrawal:You know, in people who are not overweight, those people did do better with a little bit of oil.
Dr. Monica Agrawal:I seem to remember their blood pressure was the thing that was impacted.
Dr. Monica Agrawal:I'd have to relook.
Dr. Monica Agrawal:And so Kim and I have talked about that study.
Dr. Monica Agrawal:Look, these are all pieces of the puzzle.
Dr. Monica Agrawal: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.
Dr. Monica Agrawal:You know, but you know, 70% of the world is overweight and obese.
Dr. Monica Agrawal:Right.
Dr. Monica Agrawal:And so most of the people aren't in that category.
Dr. Monica Agrawal:And so maybe they could eat a little bit more oil in their diet.
Dr. Monica Agrawal:Maybe.
Dr. Monica Agrawal:But there, you know, my study is another study that really looks at another group of people with a higher.
Dr. Monica Agrawal:Their BMI was all elevated in the overweight category.
Dr. Monica Agrawal:So all of these people, they're just different pieces of the puzzle.
Dr. Monica Agrawal:And so if you are for instance, this underweight person and you need to get fat, I prefer you get it from whole foods.
Dr. Monica Agrawal:But if you eat a little bit more oil, maybe there's more flexibility in your diet.
Dr. Monica Agrawal:For you than for somebody who has a BMI of 27 and he's at risk for heart disease.
Dr. Monica Agrawal:Every case has to be taken in isolation.
Dr. Monica Agrawal:And you know, I don't think that there's one rule and you know, Kim is, Kim and I are in literally talk twice a week sometimes.
Dr. Monica Agrawal:And so we talk about these studies and he's the first one who sent me an applause letter.
Dr. Monica Agrawal:Applause text message to say great job on that study.
Dr. Monica Agrawal:So, so he and I are not, they're not, they're not fighting each other.
Dr. Monica Agrawal:He's not saying olive oil is good.
Dr. Monica Agrawal:And so wait, this is debunking that.
Dr. Monica Agrawal:And he's saying in this sub select category in this study there was a slight improvement when they had some olive oil.
Dr. Monica Agrawal:So that's just another piece of information.
Dr. Monica Agrawal: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 a grain of salt too is that these are just pieces of the puzzle.
Dr. Monica Agrawal:I think what we should take away from this is that most of, for the 70% of people that are not over, that are overweight or obese, they shouldn't be eating olive oil if they're at risk for heart disease.
Dr. Monica Agrawal:And in general.
Dr. Monica Agrawal:And even with that lower weight class, why not eat them from your Whole Foods?
RIP Esselstyn:Yeah, yeah.
RIP Esselstyn:I mean tell me if you agree with this statement that I'm going to make here and then, and then I'm going to let you go.
RIP Esselstyn:And that is I think that olive oil, and really any oil for that matter, it's like, it's like alcohol.
RIP Esselstyn:I think, I think that the least amount is the most healthy amount.
RIP Esselstyn:And with alcohol, what is it?
RIP Esselstyn:It's like least it's a zero amount.
RIP Esselstyn:And I just, I think, I think whole food plant based, minimal to low oil is like is it?
RIP Esselstyn:And I don't know why there has to be all this arguing about it.
Dr. Monica Agrawal:Well, I think people want to live in the middles and in the in 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.
Dr. Monica Agrawal:And you know, I have no judgment there, 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.
Dr. Monica Agrawal:I, I think that everybody should continue to take away that more plant based is better.
Dr. Monica Agrawal:And if in, if you can just focus on that piece, then everything else plants won't matter.
Dr. Monica Agrawal:So much.
Dr. Monica Agrawal:And a little bit of this or a little bit of that.
Dr. Monica Agrawal:I always tell people this.
Dr. Monica Agrawal:Most people quote me.
Dr. Monica Agrawal:A little bit of this or a little bit of that, I don't really care about.
Dr. Monica Agrawal:As long as your foundation is plant.
RIP Esselstyn:Based, I couldn't agree with you more.
RIP Esselstyn:The thing that obviously you can tell irks me the most is that it's.
RIP Esselstyn:We have olive oil masking array, masking or masquerading around like it's this, this Mediterranean health food.
RIP Esselstyn:And it's not.
RIP Esselstyn:I just want people to know if you want to anoint it because you like it on your.
RIP Esselstyn:It adds spices and you like the flavor and allowed to eat more, eat more, fine.
RIP Esselstyn:But no, it's not a health food.
Dr. Monica Agrawal:Yeah, I think that's what you take away and, you know, do what you want with the.
Dr. Monica Agrawal:With the other stuff.
Dr. Monica Agrawal:I said I don't sweat the small stuff.
Dr. Monica Agrawal:I really focus on the big picture here.
Dr. Monica Agrawal:And what this tells me is that a little bit of olive oil may be okay.
Dr. Monica Agrawal:A lot of oil.
Dr. Monica Agrawal:Certainly don't need it.
RIP Esselstyn:Yeah.
RIP Esselstyn:Yeah.
RIP Esselstyn:Well, Monica, such a pleasure.
RIP Esselstyn:It really was.
RIP Esselstyn:Thank you so much.
RIP Esselstyn:And huge congrats on getting this.
Dr. Monica Agrawal:Thank you.
Dr. Monica Agrawal:Yeah, it's been great.
Dr. Monica Agrawal:Hey, thanks so much.
RIP Esselstyn:Give me a Plan Strong fist bump on the way out.
RIP Esselstyn:Boom.
RIP Esselstyn:Yeah, yeah, yeah, yeah.
Dr. Monica Agrawal:Take care.
RIP Esselstyn:Bye.
RIP Esselstyn:I know you all can tell I am just a little passionate about this subject.
RIP Esselstyn:Eliminating oils, even just for a short time, can have a profound effect on biomarkers, including inflammation, cholesterol, blood pressure, and weight management.
RIP Esselstyn:This is good news, and we hope that you find this as encouraging as we do here at Plant Strong.
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RIP Esselstyn:The Plan Strong podcast team includes Carrie Barrett, Lori Kordowich, and Amy Mackey.
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RIP Esselstyn:As always, this and every episode is dedicated to my parents, Dr.
RIP Esselstyn:Caldwell B.
RIP Esselstyn:Esselstyn Jr.
RIP Esselstyn:And Ann Krile Esselstyn.
RIP Esselstyn:Thanks so much for listening.