Mediterranean populations- Stidies indicate disease significantly lower

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Olive Oil

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Statistics have shown that Mediterranean populations such as Spain,

Italy & Greece, have significantly lower rates of coronary heart

disease (CHD) than that seen throughout the rest of the world. [1] This

observation was initially met with confusion, because the typical Mediterranean

diet is moderately high in fat.

 

Because studies among these other populations had shown a

significant association between fat intake and the risk of heart disease, it was

not known why the reverse was true among the Mediterranean people.

 

It was soon discovered that it was the " quality " , not the quantity of fat which

was associated with heart disease. The fat intake of typical American diets

consisted largely of saturated fats from animal foods such as meat and dairy,

whereas the fat intake among typical Mediterranean diets consisted largely of

monounsaturated fats from plant sources such as olive oil. It was then

discovered that diets high in monounsaturated fatty acids (MUFA's) and low in

saturated fatty acids

(SUFA's) could favourably affect blood cholesterol levels and

consequently decrease the risk of developing cardiovascular diseases

such as coronary heart disease (CHD); even when providing the same

amount of total fat.

 

Further studies have revealed that other than its high MUFA content,

unprocessed (extra-virgin) olive oil contains non-fat components

such as certain " phenolic " compounds which have been found to have a wide range

of beneficial health effects which include favourable effects on cholesterol

(both 'good' and 'bad') levels and oxidation, as well as

posessing an anti-inflamatory effect and potentially having healthy

influences on our blood pressure and blood clotting [3].

 

The rate of cancer among Mediterranean populations is also

significantly

lower than the rest of the world. There is some preliminary evidence

to suggest that these lower rates of cancer, particularly breast

cancer, may also be at least in part due to olive oil consumption, as a

component of olive oil called 'oleic acid' has shown the potential to prevent

breast cancer in laboratory studies.

For these reasons, extra-virgin olive oil intake, especially when

used to replace fat intake from saturated fat sources, should be an

important part of a nutra-smart diet.

 

Olive Oil and Coronary Heart Disease (CHD)

 

Epidemiology

 

Several epidemiological (population-based) studies have found

significantly lower rates of death from all causes, particularly

heart disease, among those whose dietary habits are closets to traditional

Mediterranean diets (rich in plant foods, olive oil and low in saturated animal

fats). [4,5]

Recently, researchers from the University Of Athens School Of

Medicine reviewed all of the epidemiological studies which evaluated the

association between adherence to a Mediterranean diet and the

occurrence of coronary heart disease outcomes. These studies showed that

Mediterranean diet adherence resulted in a reduction in the risk of CHD varying

from 8% to 45%. [6]

 

The seven countries study followed approximately 13,000 healthy

middle aged men from Europe, Japan and the U.S. for 15 years. [7]

Throughout this time, a total of 2,288 of the men had died. Analyses of the

participant's dietary habits revealed that although total fat intake

and polyunsaturated fat intake were not significantly correlated with the risk

of death, the greatest dietary correlation was the intake of monounsaturated

fats. Those who consumed a greater ratio of mono-unsaturated fats to saturated

fats had the most protection

against all causes of death, especially CHD. The greatest source of

monounsaturated fats among most of these countries was of course

olive

oil. Additionally, the populations with the highest monounsaturated

fat

intakes had the lowest rates of heart disease throughout this study.

 

A recent case-control study in Spain compared the diets of 171

patients

who had recently suffered a non-fatal heart attack, with 171 non-

heart

attack patients of the same age (age-matched controls). [8] The

results

of this study found that those who consumed the most olive oil had

an

82% reduced risk of heart attack compared with those who rarely

consumed

olive oil.

 

These studies provide at least some good evidence that adherence to

a

Mediterranean-like diet low in saturated fats and high in

monounsaturated fats, specifically rich in olive oil, may

significantly

decrease the risk of heart disease. Discussed below are some of the

mechanisms by which Olive oil may exert its cardio-protective

effect,

such as it's ability to lower total and LDL " bad " cholesterol

levels,

reduce LDL cholesterol oxidation, increase HDL " good " cholesterol

levels, inhibit unnecessary blood clotting, exert an anti-

inflammatory

action and lower blood pressure in hypertensive patients, as well as

the

potent anti-oxidant properties of olive oils non-fat components such

as

its phenolic content; particularly higher in the lesser-processed

" extra-virgin " olive oil.

 

Effect of Olive Oil on Total and LDL " bad " Cholesterol

 

Many human clinical trials have shown that replacement of high

saturated

fat diets for diets high in monounsaturated fats, mostly from olive

oil,

have resulted in a significant decrease in both total cholesterol

(TC)

and particularly LDL " bad " cholesterol; the type of cholesterol

known to

build up in the arteries and cause atherosclerosis; the hardening

and

narrowing of the arteries that may lead to blockages and coronary

heart

disease (CHD) or stroke. These results have been confirmed in

studies

involving both men and women of varying ages. [9-16]

 

Whilst higher levels of LDL cholesterol (also known as " bad "

cholesterol) are associated with the development of atherosclerosis

and

thus increase the risk of cardiovascular disease, [17-20] higher

levels

of high density lipoprotein (HDL) cholesterol, also referred to as

" good " cholesterol, is associated with a reduced risk of developing

cardiovascular disease. [21] This is because the HDL particles carry

cholesterol away from the arteries and back to the liver, whereas

LDL

particles carry it from the liver and deposit it in the arteries

where

it causes atherosclerosis and plaque build- up. Some studies have

also

shown an increase in HDL " good " cholesterol after olive oil

consumption

[22] as well as other beneficial effects on blood lipid (fat) levels

such as reduction in the levels of apolipoprotein B and beneficial

changes in platelet function. [23] This is important because higher

levels of apolipoprotein B are also associated with an increased

risk of

cardiovascular disease, and blood platelets are also involved in the

development of atherosclerosis by stimulating arterial plaque growth

when they come in contact with the inner wall of blood vessels.

 

LDL particles themselves only become a problem when they are taken

up by

a type of white blood cell found in arterial plaques called

macrophages,

and become oxidized, forming " foam cells " . When these LDL particles

become oxidized and form foam cells, this further stimulates the

progression of plaque build up in arterial walls, hardening and

narrowing the arteries. Therefore, decreasing the amount of LDL

particles in the blood is an important means of preventing

atherosclerosis development, but trying to limit the amount of

oxidization of those LDL particles that are present, is also

important.

This leads to the next important point.

 

LDL Oxidation

 

Diets high in saturated fatty acids (SUFA's) are known to raise LDL

levels whilst diets high in polyunsaturated fatty acids (PUFA's) and

monounsaturated fatty acids (MUFA's) tend to decrease LDL levels. In

fact, a meta-analysis of 27 human trials designed to examine the

effect

of polyunsaturated and monounsaturated fatty acid rich diets on

blood

lipid levels found that both types of dietary fats may potentially

lower

total and LDL cholesterol levels. [24]

 

The problem with diets high in PUFA's however, is that although they

may

decrease the total levels of LDL particles in the blood, they tend

to

create a higher concentration of polyunsaturated fats within the LDL

particles, which in turn increases the amount of LDL oxidation.

[25,26]

This is because PUFA's are more readily oxidized than MUFA's due to

the

higher number of double bonds in their hydrocarbon chains.

 

Human trials have found that subjects given a diet high in Olive Oil

and

other oils rich in monounsaturated fats such as Oleic acid, have not

only been able to lower LDL levels but significantly decreased LDL

oxidation, particularly compared to those given a high PUFA diet.

[27-33]

 

Anti-hypertensive action

 

Epidemiological studies have not always found a correlation between

fat

intake and high-blood pressure (hypertension). [34-36] In regards to

Olive oil however, a cross-sectional study which compared the fatty

acid

levels of middle aged men throughout Europe, found that Italian men

had

significantly higher tissue levels of Oleic acid ( a type of MFA

found

in Olive oil), and also had lower blood pressures.[37]

 

Most clinical trials have found no difference in blood pressure

among

normotensive subjects (people with normal blood pressure) when given

Mediterranean-type diets. [38,39] One trial however found that

healthy

patients given a diet high in Olive oil (40% fat, 22% MUFA) had

reductions in blood pressure when compared to those given the

National

Cholesterol Education Program (NCEP) Step 1 diet (30% fat, 12% MUFA)

[40]

 

Another trial found that giving a diet high in saturated fats to

people

who were used to consuming a Mediterranean style diet (low in SFA,

high

in MUFA) significantly increased their blood pressure. When they

resumed

their normal Mediterranean style diet however, their blood pressure

went

back to normal. [41]

 

These studies however examined the effect of Olive oil containing

diets

in normotensive people (people with normal blood pressure). The

results

of a randomized, crossover trial involving 23 hypertensive patients

(people with high-blood pressure) who were given different diets

over a

year, found that extra virgin olive oil significantly decreased the

need

for anti-hypertensive medications. It was suggested that this occurs

due

to the ability of phenolic compounds found in un-processed

(extra-virgin) olive oils to enhance nitric oxide (NO) levels. [42]

This

study provides preliminary evidence that whilst Olive oil may not

significantly affect blood pressure in normotensive individuals, it

may

have at least some beneficial effects in patients with high blood

pressure.

 

Non-fatty acid components

 

Although it has been speculated that the beneficial effects of a

Mediterranean-like diet are due to certain MUFA's such as Oleic acid

in

Olive oil, recent investigations have found that the non-fatty acid

component of olive oil such as certain phenols, possess beneficial

biologic activities that may contribute to the lower incidence of

coronary heart disease (CHD) in the Mediterranean area. [43] This is

why

Olive oil, particularly " extra virgin olive oil " , may be healthier

than

other foods and oils high in MUFA's. In fact, the main peculiarity

of

extra-virgin olive oil is the presence of remarkable quantities of

phenolic compounds which not only provide high stability and strong

taste but may be at least in part responsible for extra-virgin olive

oils anti-atherogenic potential (the ability to inhibit the

development

of atherosclerotic plaques). [44,45]

 

Many of these beneficial phenolic compounds are not present in other

oils, and are lost in the processing that occurs in olive oils other

than those classed as " extra virgin " . " Extra-virgin " olive oil is

considered the best, is the least processed and is made from the

first

pressing of the olives. " Virgin " olive oil comes from the second

pressing and has lost much of the beneficial phenolic

compounds. " Pure "

olive oil is actually even less pure than " virgin " and " extra-

virgin "

because it undergoes more processing such as filtering and refining.

" Extra light " olive oil undergoes even more processing. Because

further

processing results in further losses of these antioxidant phenols,

" extra-virgin " olive oil is the most pure form and contains the

highest

concentration of phenolic compounds.

 

Among the protective phenolic compounds found in extra-virgin olive

oil

are the antioxidants Hydroxytyrosol [46] and oleuropein, both of

which

are readily absorbed by the body [47] and have shown to possess

potent

free-radical scavenging properties. [48] Studies have shown that

administration of even relatively low doses of olive oil phenols can

significantly increase antioxidant levels in the body and decrease

oxidative stress in both humans [49] and animals. [50]

 

Anti-inflammatory effect

 

Laboratory studies have also shown anti-inflammatory effects of

olive

oil. Rats fed virgin olive oil had less inflammation when injected

with

carrageenan (a substance used to induce arthritis) than what rats

fed

other oils did. Moreover, the rats fed virgin olive oil with an

added

phenolic component (similar to that found in extra virgin olive oil)

had

even less inflammation. [51]

 

A similar study found that both the " un-saponifiable fraction " (non-

fat

portion) of virgin olive oil including beta-sitosterol and

erythrodiol,

as well as its phenolic compounds oleuropein, tyrosol,

hydroxytyrosol

and caffeic acid, all exerted a significant anti-inflammatory effect

almost as effective as the anti-inflammatory drug indomethacin (an

NSAID) did. [52]

 

The anti-inflammatory properties of olive oil's non-fat components

may

also contribute towards its cardio-protective effects, as

inflammation

and inflammatory responses of the vascular endothelium are known to

play

an important role in the development of atherosclerosis. [53,54]

 

Anti-platelet activity

 

Laboratory studies have also found that 2-(3,4-di-hydroxyphenyl)-

ethanol

(DHPE), a phenol component of extra-virgin olive oil with potent

antioxidant properties, is able to inhibit platelet aggregation

(blood

clotting) more effectively that other flavonoids (a class of

antioxidant

polyphenols found in plant foods known to have potentially healthful

effects on a multitude of common chronic health problems). The

phenol

enriched portion of olive oil also demonstrated similar activity.

[55]

 

This is important because heart attacks and strokes are caused by

blood

clots which build up in the arteries of the heart or brain which

have

been narrowed due to atherosclerotic plaque formation. The ability

to

form normal blood clots to physical trauma is of course necessary to

prevent haemorrhage (uncontrolled bleeding), however the degree of

blood

clot inhibition which would occur due to olive oil consumption would

not

be so severe that it would be dangerous at all.

 

Anti-Oxidant Components

 

Olive oil is very high in vitamin E, but other than that, most of

its

antioxidant properties come from its phenolic components. Phenolic

compounds such as flavonoids are widespread in many plant foods and

influence the quality, palatability, and stability of foods by

acting as

flavourants, colourants, and antioxidants. When consumed, certain

phenolic compounds are known to exhibit pharmacological effects on

the

body, such as anti-carcinogenic (anti-cancer), anti-inflammatory,

anti-oxidant, anti-atherogenic effects etc. [56]

 

Laboratory investigations have found that the phenolic constituents

of

olive oil can significantly inhibit the oxidation of LDL " bad "

cholesterol. [57,58] Animal experiments have revealed that greater

reductions in LDL oxidation occurred in rats, rabbits and hamsters

when

fed olive oil than when fed oils similar to olive oil other than its

phenolic components. [59-61] Human investigations have revealed

greater

reductions in LDL oxidation when given extra-virgin olive oil or

virgin

olive oil with a higher phenolic content than when given other olive

oils. [62,63]

 

These studies suggest that the reduction in LDL oxidation that

occurs

after consumption of extra-virgin olive oil may be due to its

phenolic

constituents rather than just its monounsaturated Oleic acid and

vitamin

E content.

 

 

Animal studies have shown that rats fed olive oil enriched with the

non-fatty acid components had greater beneficial effects on

HLD " good "

cholesterol than did those fed ordinary virgin olive oil, or oil

enriched with Oleic acid. [64] This study suggests that substances

other

than the fatty acid in olive oil may exert beneficial effects on the

cardiovascular system.

 

The Bottom Line

 

This evidence strongly suggests not only that Olive oil has superior

protective effects than other foods high in monounsaturated fatty

acids

(MUFA's) due to its non-fat components, but extra-virgin olive oil

may

be the most beneficial type of olive oil due to its higher

concentration

of these protective non-fat components, including a variety of

phenolic

compounds and other antioxidants.

 

Olive Oil and Breast Cancer

 

Epidemiology

 

It has been found that the rates of cancer among the Mediterranean

populations are significantly lower than the rest of Europe and the

United States. This has been attributed to the high dietary intake

of

plant foods and olive oil. [65] Although it has been observed that

per

capita fat consumption around the world is highly correlated with

breast

cancer incidence and mortality, [66,67] the incidence rates of

breast

cancer in Mediterranean countries are relatively low compared with

those

in most other Western countries [68] despite Mediterranean diets

being

relatively high in fat. In fact, the incidence of breast cancer in

Spain

is about 40% lower than that in the U.S, Canada or northern Europe.

[69]

Studies have shown that Greek women derive approximately 42% of

their

energy intake from fat, (mostly from olive oil), [70] however they

have

a substantially lower rate of death from breast cancer than women in

the

U.S, despite American women deriving only 35% of their average

energy

intake from fat. [71]

 

Several case-control studies throughout Mediterranean populations

have

found that women who consume olive oil frequently have a reduced

risk of

breast cancer. Among these was a study in Spain which compared the

diets

of 100 breast cancer patients with 100 women without breast cancer.

The

results showed 70% less breast cancer among frequent consumers of

olive

oil. [72]

 

Another study in Greece compared the diets of 820 women diagnosed

with

breast cancer and 1,548 women without breast cancer. This study

found a

25% reduction in breast cancer risk among the more frequent

consumers of

olive oil. [73] The other case-control studies conducted in Spain

[74]

and Italy [75,76] also found a modest protective association between

olive oil consumption and breast cancer.

 

Oleic Acid

 

Although it is not clear precisely what component of olive oil its

protective effect on breast cancer can be attributed to, it has been

suggested that a type of fatty acid called Oleic acid may be at

least in

part responsible. Animal studies have found that olive oils higher

in

Oleic acid have prevented carcinogen-induced breast cancer better

than

olive oils with lower concentrations of Oleic acid. [77]

 

Recent Laboratory studies have found that Oleic acid can induce

apoptosis (normal cell death which fails to occur in cancer cells)

in

breast cancer cells. It was found that Oleic acid can significantly

reduced the levels of a gene called Her-2/neu - which is thought to

trigger breast cancer. [78] This gene is found in high levels in

around

one in five breast cancer patients and is associated with a poor

prognosis.

 

Further research is needed to better understand what kind of anti-

cancer

activity olive oil may possess.

 

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