Why Was Heart Disease Rare in the Mediterranean?

Image Credit: Couleur / Pixabay. This image has been modified.

What’s the Mediterranean Diet’s Secret?

The Mediterranean Diet is an “in” topic nowadays in both the medical literature and the lay media. As one researcher put it, “Uncritical laudatory coverage is common, but specifics are hard to come by: What is it? Where did it come from? Why is it good? Merits are rarely detailed; possible downsides are never mentioned.” So, let’s dig in….

After World War II, the government of Greece asked the Rockefeller foundation to come in and assess the situation. Impressed by the low rates of heart disease in the region, nutrition scientist Ancel Keys—after which “K” rations were named—initiated his famous seven countries study. In this study, he found the rate of fatal heart disease on the Greek isle of Crete was 20 times lower than in the United States. They also had the lowest cancer rates and fewest deaths overall. What were they eating? Their diets were more than 90% plant-based, which may explain why coronary heart disease was such a rarity. A rarity, that is, except for a small class of rich people whose diet differed from that of the general population—they ate meat every day instead of every week or two.

So, the heart of the Mediterranean diet is mainly plant-based, and low in meat and dairy, which Keys considered the “major villains in the diet” because of their saturated fat content. Unfortunately, no one is really eating the traditional Mediterranean diet anymore, even in the Mediterranean. The prevalence of coronary heart disease skyrocketed by an order of magnitude within a few decades in Crete, blamed on the increased consumption of meat and cheese at the expense of plant foods. 

Everyone is talking about the Mediterranean diet, but few do it properly. People think of pizza or spaghetti with meat sauce, but while “Italian restaurants brag about the healthy Mediterranean diet, they serve a travesty of it.” If no one’s really eating this way anymore, how do you study it?

Researchers came up with a variety of Mediterranean diet adherence scoring systems to see if people who are eating more Mediterranean-ish do better. You get maximum points the more plant foods you eat, and effectively you get points deducted by eating just a single serving of meat or dairy a day. So, it’s no surprise those that eat relatively higher on the scale have a lower risk of heart disease, cancer, and death overall. After all, the Mediterranean diet can be considered to be a “near vegetarian” diet. “As such, it should be expected to produce the well-established health benefits of vegetarian diets.” That is, less heart disease, cancer, death, and inflammation; improved arterial function; a lower risk of developing type 2 diabetes; a reduced risk for stroke, depression, and cognitive impairment.

How might it work? I’ve talked about the elegant studies showing that those who eat plant-based diets have more plant-based compounds, like aspirin, circulating within their systems. Polyphenol phytonutrients in plant foods are associated with a significantly lower risk of dying. Magnesium consumption is also associated with a significantly lower risk of dying, and is found in dark green leafy vegetables, as well as fruits, beans, nuts, soy, and whole grains.

Heme iron, on the other hand—the iron found in blood and muscle—acts as a pro-oxidant and appears to increase the risk of diabetes, whereas plant-based, non-heme iron appears safe. Similarly, with heart disease, animal-based iron was found to significantly increase the risk of coronary heart disease, our number one killer, but not plant-based iron. The Mediterranean diet is protective compared to the Standard American Diet—no question—but any diet rich in whole plant foods and low in animal-fat consumption could be expected to confer protection against many of our leading killers.

Here are some more videos on the Mediterranean Diet:

For more information on heme iron, see Risk Associated With Iron Supplements

More on magnesium is found in How Do Nuts Prevent Sudden Cardiac Death? and Mineral of the Year—Magnesium.

And more on polyphenols can be seen in videos like How to Slow Brain Aging by Two Years and Juicing Removes More Than Just Fiber.

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Discuss

Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.


115 responses to “What’s the Mediterranean Diet’s Secret?

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  1. The consumption of XV olive oil in the original Med diet used to be considered healthful. The PREDIMED study showed modest benefits of XV consumption.

    However, supposedly, any oil consumption damages the endothelial layer of our blood vessels – at least temporarily. Dr. Esselstyn is red-faced adamant that no oil should pass our lips.

    What’s a novice like me to think?

    1. Richard W: Here are some thoughts for you: It’s my understanding that studies showing consumption of olive oil having some benefits are usually showing benefits *relative* to eating something worse, like say butter. Even so, those pro-olive oil studies do not show *reversal* of heart disease or any disease by eating olive oil. In other words, you can eat olive oil and lessen your risk, but some/significant risk is still there. When people want to know what is a healthy food, that’s not usually the criteria that they would find acceptable.
      .
      Esselstyn is especially concerned with helping people with advanced heart disease and with reversing the flawed thinking in our society that extracted oils are necessary and/or health foods. My personal take on it is to treat oil like sugar. No one thinks that sugar is healthy, but the occasional dish or dessert with sugar it, in the context of an otherwise whole plant food diet, is not likely to be harmful, especially to a healthy person.
      .
      What do you think? Does that help?

      1. Thanks Thea for your thoughts.

        As I read the abstract of the PREDIMED study, the XV oil group was instructed to add the oil to their diet. This group showed a modest decline in CV events over the 5 years study. I don’t believe they were instructed to substitute the XV oil for anything else – it was in addition to whatever they were eating.

        So, even though the results were modest, they were improvements, not backsliding. I would never expect any consumption of XV oil to help reverse CV disease.

        So, bottom line, I think your final thoughts about a healthy person safely having slight amounts of XV oil is probably spot on. I consume probably 1 tablespoon a day and unless I hear a rumbling of thunder from the heavens, I’ll continue to do so.

        1. Richard W: One more thought for you. :-) If you were instructed to add some oil to your diet over 5 years, you would be eating less of something else naturally, unless you were somehow forced to be consuming more overall calories. I can’t imagine that they did calorie counting over 5 years, especially for any sizable number of study participants??
          .
          A tablespoon of oil a day seems like a lot to me. However, I’m not an expert, and I don’t know anything about your diet or situation. So, of course, you have to make that call for yourself. Good luck!

          1. Richard W: I agree totally with Thea, especially that on tablespoon oil a day is to much…(right in the beginnig of my plant-based life I did it so and my cholesterol rised up in few weeks, despite…)
            on thought in addition (of Hteas)
            If I understood al the issues about “oil” consumption right, so is the view of Dr. Esselstyn, that a “healthy person” has a cholesterol under 150 mg/dl and a LDL under 70 mg/dl – if you have some level for some times in the life over that, the danger of having already plaque inside your venes is given. If you then take in consider that 30 % of all heart attacks occur betwen a cholesterol level from 150 – 200 (which is maintain considered as save by the “normal” physicans) then is every intake of raffined oil like russian roulette. Because, so Dr. Esselstyn and others, the plaque wich has been build up in the state between 150 – 200 mg/dl of cholesterol is more instabil then if you have more plaque. I don’t know if I have this clairly explaint. Let’s try with an example: If you have only a little plaque here and there in your arteries the blood flow is quite normal (most people have a a RR 120/80) and arteris can still dilate if there is necessary, with the plaque inside. So, imagine you, because you are feeling good you go on a run. You run a while and your arteries going dilate, the blood started to go faster, because you need more oxygen in your muscle cells. If your plaque now is instabil, the possibility that a little piece of plaque burst is muc higher as if you have more plaque inside your arteries and they are already more stif. This is much simplified, I know, but if you read the story of Dr. Joe Crowe (in the book of Dr. Esselstyn) then it make sense, because he was in his forties, he has no high blodd presurer ( RR), he was not overwight and he had not a bad cholesterol count, when he get his heart attack.
            On December 31st, 2016 there was a news on the radio here in Bavaria.
            The Mayor of Memmingen died during a jogging trail by a heart attack this morning. He was 46 and left his wife and two kid over. (They said at the news) It is not understandable because he was a endurance sportsman with no healthy problems… (maybe exactly this was the problem, because if you have no problems yet, you will not go to your physican for a check and even if you go, if your cholesterol is under 200 the doctor will say: all is fine…)
            I don’t like to frighten you but if you already consider about taking oil or not, may it is worth to take this also in cosideration. ;-) And hej, once you gave up using rafined oil (in addition) you will not miss it after a while.

        2. It’s my understanding there is no nutritional value in OILS and when you want to be heart healthy, why take any oil. Oil seems to be another commercial product necessary as an ingredient in less than healthy food. Just an old man’s opinion, I’m not scientific.

        3. Hi Richard – here’s some additional information to mull over. It takes 44 olives to make 1 Tbs of oil. For coconuts, it takes 1/2 coconut to make the same amount. A post above reports that it takes 14 ears of corn for 1 Tbs.
          I’m not trying to talk you into or out of anything . . . I just find this information interesting to think about when I think of using oil. Especially when I think about the fact that for that same amount of calories in oil, I could eat that much food.
          Have a great new year!

      1. That’s a fine article Tom. So it’s clear that XV oil doesn’t do a body any good.

        So, my bottom line question is – how harmful it the 1 tablespoon/day that I consume.

        1 Tbs = 120 calories = 17 calories of saturated fat = <1% of my total caloric intake.

        Seems like that should be OK.

        1. Hi Richard W. I know plenty of people have already posted comments on your argument, however have you thought about it like this: 1 Tbsp oil = 120 cal. If you’re hypothetically consuming 2000 Cal/day, then just that 1 Tbsp oil gives you 6% of your daily calories from fat. (Oil = pure fat calories) If you’re aiming for a low fat diet of 10% of calories from fat, that doesn’t give you much room to consume the fat calories naturally present in whole plant foods. It would take about 14 ears of corn, for example, to make 1 Tbsp corn oil. You’d be pretty full off 14 ears of corn, but that 1 Tbsp of oil would hardly fill you up. Just some food for thought.

          1. NF-Stephanie – You are helping to make the point that I’ve been trying to make and have posted on this thread today (and at other times). It takes 44 olives to make 1 TBS of olive oil. One could have a boatload more enjoyment and fulfillment if they incorporated the whole olive.
            I would love to know how this idea got started that slathering our food in various oils is somehow healthy. All the plant-eating mammals of the earth don’t slather olive oil on their salad and they do just fine. In fact, they get all the benefits of the fat in their vegg from the vegg itself; they don’t extract it. Ever see a whale looking for its salad dressing to go on its algae? Never!
            :-)

      2. hi Tom, thank you for posting the article with the link to the study as well. I did have a question http://atvb.ahajournals.org/content/15/12/2101.full under Discussion, last sentence of third paragraph, it did mention that polyunsaturated fats have been repeatedly shown to decrease CAA in primates. (im on a tablet and cant copy/paste the sentence, sorry.) Much of the study details went over my head, but I was wondering if then 1 or 2 tsp of safflower oil or canola then would do no harm? The pritikin article focussed on the deleterious effects of olive oil but did not elaborate on the relatively positive findings on polyunsaturated fats. Do you personally feel that leaving oil off the menu is the best course? thanks Tom !

        1. Susan for me I remember a bit of Dr Greger’s wisdom when I went to hear him at a local lecture in my neighborhood. He pointed out that with olive oil you are throwing away all the good part of the olive to use the oil. WFPB being key. Oil is processed.

          1. Excellent reminder WFPBRunner, and so far the wfpb part of the plan has been the key to so many people’s successes.. NOT the exceptions!

          2. And there is no nutritional value in oils. So why use them? The commercial food company’s need them for their products. And seems some recomended for loosing weight.

        2. Thanks Susan. What it says in full is this “Polyunsaturated fat–rich diets as compared with saturated fat–rich diets have been repeatedly shown to decrease CAA in primates” – the key point for me being “compared with saturated fat-rich diets”. That is setting the bar pretty low.

          The other point is that if we want to increase our intake of PUFAs, we can eat more nuts and seeds. Or tofu for that matter. Similarly if we want more MUFAs, we can eat olives, nuts and avocados. Oils and spreads are unnecessary. So, yes, I personally do not use oils or spreads.

          Another point worth bearing in mind is that greater dietary PUFA consumption can degrade our body’s ability to produce beneficial long chain PUFAs. Consequently, I do not see any need or benefit to trying to boost dietary fatty acid consumption.
          https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4574498

          Having said that, the science on this is not well developed and there are contrary beliefs.
          http://www.health.harvard.edu/staying-healthy/the-truth-about-fats-bad-and-good

          However, offhand, I cannot recall a study showing an absolute benefit from consuming concentrated fat in the form of oils, spreads or whatever as opposed to relative benefits from consuming one type of fat compared to another. The possible exception is the eco-Atkins diet study but there the high fat diet was “vegan” while the (only relatively) low fat diet was a lacto-ovo diet – so strict comparisons are not really possible. And it was only 6 months.
          http://bmjopen.bmj.com/content/4/2/e003505.full

          1. Thank you Tom for your detailed response and for the links. I’ll enjoy going through them. The quoted statement containing the phrase ‘ decrease CAA’ (atherschlerosis) in primates is what caught my eye, but now I understand that its in comparison witn the saturated fats. ( Just as an aside , I find it eery that rarely does it come up that we consumed tubfuls of transfat containing margarines for decades. Its like it just disappeared. )
            Thank you again for your thoughts on this… I will be sticking to the whole foods!

    2. Probably not very helpful, just a personal observation, but I had all the typical modern ailments, which improved greatly after going WFPB, but bigger and faster changes happened and long standing diabetes reversed when I finally cut all added oil, which was XV…so it was obviously NOT helping. It was a challenge at first, but after a while it was actually distasteful and rather gross. We’ve developed a lot of modern tastes, but I can’t imagine our evolutionary ancestors going through the wasteful process of pressing out the fat and throwing away the nutrients and fiber, because it isn’t filling or a food at all, just concentrated,fiber depleted, nutrition-less calories. It’s another modern version of sugar, empty calories that can be spent much better eating real nutritious, and satisfying food, rich with needed fiber, antioxidants, vitamins and all the various goodies. I can’t afford to play Russian roulette with opinions and controversy, so I choose to respect Dr Essy’s trained observations and err on the side of caution, but YMMV.

      1. Kendrick is a dangerous quack. There is no other way to describe him.

        What he and the authors of that revisionist interpretation of the MCE study fail to mention is that, in the 1960s and 1970s, oils and spreads were routinely hydrogenated ie they were high in trans fats. It is therefore not surprising that the revisionists were able to find/generate new figures appearing to show that consumption of PUFA oils and spreads resulted in higher mortality.

        They certainly can’t find such results for more modern studies which have controlled for the effects of trans fats. These show that replacing SFAs with PUFAs reduce adverse events and mortality.

        He also mentions the McGovern Report, Dr G’s video on this is worth watching
        http://nutritionfacts.org/video/the-mcgovern-report/

    3. Context: Esselstyn was getting asked about oil consumption by two groups of people, those who wish to prevent disease and those who already have it. For the latter group his advice needed to be clear, “NO OIL”.

      take it or leave it.

    4. Were we eating refined oils for the first 20 million or so years we were evolving, before a few thousand years ago when they started refining oils? I guess not. Probably weren’t designed to handle the stuff.

    5. One of the toughest problems in trying to evaluate the damage or benefits of olive oil is that most of the extra virgin olive oil you see in the store is not pure extra virgin olive oil. It is imported into Italy, then called “Italian olive oil”. The amount of fraud is very frequently described in the media. The mafia is involved and it is hard to tell. Trader Joe’s tells you that theirs is authentic, but everyone will say that and it’s not worth much. I only use olive oil from an independently verified olive oil evaluator, and then not very much.

    6. I suspect that one reason–beside the fact that it is fat–that Esselstyn forbids ALL oil in his reversal diet is that if you start using just a little , you will eventually start using more. It doesn’t add nutrition to the food, but it does add “mouth feel” and other things we crave. So the way to avoid using too much, is to avoid using any.

  2. Fish consumption was common on the original medit. diet, or wasn’t it? Low in saturated fat, high protein fish, full of omega 3, B12, iodine, selenium, vitamin D, all in a complete package. What role did this play in health promotion?

    1. According to the research requested by the Greek government (second paragraph) the diet was 90% plant based. So was fish consumption 10%? If you read the Blue Zone work you will see that the longest lived communities eat fish etc about in the same amounts–on special occasions. They are all primarily plant based.

      10% is definitely much different than what is common in the US.

      1. And 10 percent is more than zero-percent. I wonder if the 10 percent is better than zero.

        I also if the 10 percent fish consumption prevents the need to buy factory made vitamin supplements
        to get adequate B12, D, omega 3, etc.

        1. You think those supplements are necessary in your diet? You could drink and eat unwashed foods and get outside more often. Eat flax seeds?

              1. I believe guest’s point is if you eat WFPB you must take supplements. You could take B12 in supplement form (pill or fortified milks) or we could drink from cow paddy stream! (I prefer the pill.) I did that once. I was sick for a while with that little bug.

                1. When I was a kid a group of us were backpacking in the desert mountains outside Phoenix. Even though it was early in the year, it was already very hot and we went through the water we packed in that should have lasted us two days in the first day. Our maps showed a water source and so we hiked over to it. Turned out that it was a stock pond that the Forest Service had put a concrete box full of sand on the outlet with a spigot where we could get “filtered” water. The pond was a deep emerald green and was still pretty green after going through the sand filter! Lots of iodine purification tablets kept any of us from getting sick, but it then it tasted of iodine flavored “green” water.

            1. B-12 is the only issue with a hygienic whole foods plant based diet. B-12 only comes from bacteria, animals only serve as a vector to collect this B-12 for us. It is no less “natural” to grow bacterial cultures and then extract the B-12 they produce and put it in a tablet. And for this one nod to modern technology we get to benefit from all the health advantages of a whole-food, plant-based diet with none of the negatives that come from animal foods (saturated fat, cholesterol, IGF-1 stimulated by animal protein, zero fiber, bio-accumulated environmental toxins (mercury, PCB, Dioxin, pesticides, etc.))

          1. #guest: Consider also such events like Fukushima, the expansion on traffic on the ocean (most ocean ships run by heavy oil), the oil-tank-disasters with the attempt to undermine the oil from the ships with chemicals. Or think on Deepwater Horizon. Have you ever seen pictures of staving sea animals because of eating plastic? Very delicious… ;-)
            And don’t forget, the ocean is still the biggest dump, look at pictures of coasts in Africa and Asia, do you think this has no effect on the seafood?
            I think they more the world gets polluted they less we should eat any animal based food, because we are the last in this nutrition chain.

    2. Welcome, guest. I am Christine, a NF volunteer moderator. I must agree with WFPBRunner’s comment. A diet that is 90% plant-based would have only 10% from all other sources, including fish. With the exception of vitamin B12, which is made by bacteria living in soil and water, and vitamin D, which is produced in sun-exposed skin, all of the other nutrients you cite can be obtained from whole plant foods. There are risks associated with fish consumption. You might want to check out these resources:
      http://nutritionfacts.org/video/red-fish-white-fish-dark-fish-atrial-fibrillation/
      http://nutritionfacts.org/video/fish-brain-food-older-adults/
      I hope that helps!

    3. In the time of the Rockerfeller study (just after the war) they only eat 6 ounces of fish a week. The further from the sea the less fish (this was not extremely close to the sea). As I stated the in my previous post… they also ate 1.7 ounches of snails and 7.5 ounces of meat per week. Also if you do some research… cheese/eggs and also plant based sources were high in omega-3 compared to other places.

    4. Remember that fish eating being common (which means ‘done often’) does not mean that it was also large amounts. Two ounces of fish consumed twice per week is not comparable to the 1/2 lb of flesh that we in the US eat as our “common” amounts. Common does not also mean every day.
      And salmon is not low in fat – a 7oz portion has 13 grams of fat. Cook it in fat or add tarter sauce and you’ve got a fatty mess.
      Thanks!

  3. According to the Rockefeller foundation study they eat 7.5 ounces meat per capita per week, 1.7 ounces of snails per person per week, 6 ounces of fish per capita per week and 1 egg per week. To get the facts clear.

      1. Well it’s eating meat 2 times a week and 1 times a week fish. Note that most were fasting of meat 2 times a week, because of the fasting traditions of the greek orthodox church.

    1. Do you have any information on the cardio vascular disease rates of this population? When most people quote a very low CVD rate they are referencing the study that looked at the people on Crete in the years after WWII that were per force eating a nearly vegan whole plant food diet with lots of wild green and getting a very substantial amount of exercise as the hiked around the hilly island gathering those greens. I would be very interested to see what the CVD rate of the people in the Rockefeller study were and how they compared to those on Crete.

      1. Hi Jim,

        The Rockefeller actually was a study done in Crete in 1948. The other study with the very low CVD figure is the 7 countries study from the sixties. The diet between the studies was comparible,,, although in the sixties milk consumption was a lot higher. This diet of the seven country studies was defenitely a plant based diet, but not vegan. Because 200 ml of milk was drunk every day and 245 gram of meat a week and 175 grams of eggs a week. (Food consumption patterns in the 1960
        in seven countries). Cheese only 13 grams a day.

        There is information on CVD in the rockerfeller study (I remember it), it was a third (if I remember well) as the CVD risk of the USA back then in the 1948. But this probably was for the whole country of Crete (I’m not sure.. this needs to be double checked)

        You can find the study online somehwere: Crete: A Case Study of an Underdeveloped Area. It’s behind a “pay wall”.

  4. My Italian auntie, born on the “other side” would have escarole for breakfast. As far as I know, butter never passed her lips. As a child she ate what the family raised and the family did not keep a cow or goat, so no dairy. She told me that a bunch of households shared one cheese grater for the odd time they would have a bit. What we now consider Italian food is what immigrants ate because it made them feel rich. No longer did they have to eat out of the garden like peasants, now they could have meat and cheese whenever they wanted it because in Americna “the streets are paved with gold.” Sadly, for italians, they were also paved with coronary artery disease.

  5. You are right, I live in italy and everyone thinks we live near the Mediterranean, therefore pizza and (refined) pasta with tomato sauce are the best things you can eat. Meat was less abundant than today when I was little but I did grow up with lots of pasta, tomatoes and veggie soup. Processed foods like Nutella and other junk food too, although usually italian families tended to limit those (very much compared to the States). Why noone starts a study on raw foodist (80-10-10) I wonder…mostly fruit, no oil, only whole natural foods. Now there are enough people following this diet, they should do a study..

  6. I think the public is totally confused as to what the Mediterranean Diet is. My Uncle’s doctor told him to eat a Mediterranean Diet and my Aunt remarked, “I think that means we’re supposed to eat lots of chicken and fish”.

    1. Or since everybody likes olive oil, and it is a common feature of all of the widely differing diets eaten in the Mediterranean basin, that must be why disease rates are lower. And so everyone thinks they are eating a “Mediterranean” diet by pouring olive oil over everything and can’t understand why they are gaining weight even faster than before. Obviously ignored is the fact that high fruit, vegetable and legume consumption is also a common feature of all the different Mediterranean diets. But who want to be told yet again to “eat more vegetables” when they can instead get permission to eat more fat.

      And of course the recommendation completely ignored is that fact the much lower heart disease rates and other chronic disease rates occurred in the past in specific areas of the Mediterranean and that the “Mediterranean” diet consumed today in most places is only slightly better than the highly lethal standard western diet in its ability to cause chronic disease.

    2. VegGuy, I agree that the public is confused about “The Mediterranean Diet”. Tom Goff, above, often clarifies the information about the MD on this site. But I think it would be helpful for physicians to specify that it was the “Original” (my quotes) Mediterranean Diet that was most healthful. I recently saw a physician recommend “The Mediterranean Diet” that included not only fruits and vegetables but chicken, fish, small amounts of beef and dairy. That’s not different from SAD at all. I’m not sure that the Doc’s really understand the distinctions. I’m thinking that they’re just parroting information.
      Thanks for your comments

  7. There is an important aspect not mentioned here. The preponderance of the studied population on Crete at the time subscribed to a form of Greek orthodoxy that required weekly fasting.

  8. I am English living in Spain for the last 20 years. It’s not just the diet!! Yes they eat well, and healthily, except for the meat of course, but it’s the way of life. They walk a lot, walk slowly, too. They rest up (siesta) and have a lot of sex!! They are very family oriented, so they don’t argue much. All of these things add up to a relaxed way of life which will lead to longevity. i repeat: it’s not just the diet!

    1. Nobody exactly accuses the Japanese or the inhabitants of Hong Kong of having a relaxed way of life, yet they have even greater longevity than the Spanish.

      So I don’t think we can ascribe it all to lack of stress either.

  9. Just curious about the use of the term “coronary heart disease.” Doesn’t coronary mean heart? Isn’t the term redundant? Why not “coronary artery disease,” or just heart disease?

    1. Good question, Trena. When it comes to terminology in physiology (or really in any science or just about any discipline), there are a lot of different ways that things are categorized and then labelled. And sometimes there is overlap and contradiction. In physiology for many years something in the body that was discovered might be named after the person who discovered it – Crohn’s Disease and Alzheimer’s and the ‘islets of Langerhans’ in the pancreas are just a few examples. But at some point efforts to be more descriptive were made.

      I don’t know the history of heart and blood vessel terminology but according to my Stedman’s medical dictionary, ‘coronary’ means 1) relating to or resembling a crown 2) encircling; denoting various atomic structures like nerves, blood vessels, ligaments and 3) denoting the coronary blood vessels of the heart.

      Coronary artery disease refers specifically to the arteries that go directly into the heart (as opposed to arteries elsewhere in the body.) Coronary artery disease is a type of ‘heart disease,’ which is why those two terms are not interchangeable–because there are other types of heart disease too such as angina, arrhythmia, heart failure, etc. This CDC post describes the terms https://www.cdc.gov/heartdisease/other_conditions.htm Not sure that entirely answers your Q. But hope it helps bring a little bit of clarity! – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬‬‬‬‬‬

      1. Yes, it may be amusing to note that the saturated fat advocates play on exactly this sort of terminology problem to make their case.

        For example, Donald W Miller – a cardiothoracic surgeon I think – argues that when Americans were eating mainly animal/saturated fats at the beginning of the 20th century, coronary heart disease was unknown (about 3 minutes in)
        https://www.youtube.com/watch?v=vRe9z32NZHY

        He is quite correct because he first known use of the term “coronary heart disease” was apparently in 1949.
        https://www.merriam-webster.com/dictionary/coronary%20heart%20disease

        He says that tuberculosis, pneumonia etc were the leading causes of death at that time. They were.

        He uses all of this to imply that when animal/saturated fats were the primary fats in the US diet at the beginning of the 20th century, there was no heart disease. But what neither Miller nor his ilk mention is that in 1900, “diseases of the heart” and “intercranial lesions of vascular origin” (individually 4th and 5th respectively)- ie cardiovascular diseases – together were the leading cause of death in the US.
        https://www.cdc.gov/nchs/data/dvs/lead1900_98.pdf

    2. Semantics, Trena. As you probably know, Heart Disease refers to ALL diseases of the heart such as such as congestive heart failure (CHF) which involves the left ventricle. By saying Coronary heart disease one is clarifying that the cause of the heart disease is related to the coronary arteries, not the left ventricle. But yes, coronary artery disease (CAD) refers to the same condition. Laymen often many folks leave the “C” off CHF so to just say heart disease might confuse the issue, not clarifying what the problem is.
      Hope that’s helpful.

  10. On the olive oil thing:(I’ve been on the WFPB for the past year:-)) but I have not reduced my BS as much as I had hoped. Still 95-103), I’ve read in Mateljan’s Worlds Healthiest Foods.org that cooking with oils is toxic but adding small amounts after cooking increases absorption. I’m doing that but maybe it explains my BS level. I know I could use nuts or avocados instead of OO but I do like the OO. Maybe I could grind up a couple of whole olives? But what do you know about adding small amounts of oil to cooked veggies?

    1. Kate, Is 95-103 your fasting blood glucose level? Because you are clearly in the normal range, albeit perhaps a bit high if it’s fasting.

      Many of the doctors who use a WFPB diet to treat or reverse diabetes, as you probably know, like to keep the diet low fat, and that means cutting out the oil. The comment you cite ‘adding small amounts (of oil) after cooking increases absorption’ has some truth to it, but it’s a bit of a general statement that really needs some added caveats. I wouldn’t use that statement as an excuse to slather on the oil!

      Certain fat-soluble vitamins, such as Vitamin D, will be have greater absorption if fat is present when the nutrient is in our digestive system. (Similarly, iron is better absorbed if vitamin C is present.) So the statement from the book you cited sounds like it’s simply referring to that–any fat-soluble nutrients in a meal will have enhanced absorption if you include some olive oil in the meal.

      This is true, but what’s also true is that you also don’t need processed un-whole olive oil for this to occur. You can throw in some nuts or seeds that contain fats, or, yes, whole olives. Or you could eat a salad with some avocado in it with that meal.. Generally the more ‘whole’ and unprocessed our nutrient sources are, the more of a multitude of other nutrients we also get with the food. So we’re better off choosing the whole food rather than the processed food (oil) to enhance fat-soluble nutrient absorption. – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬‬‬‬‬‬

      1. @disqus_fa9sx33qPx:disqus Also don’t forget that, like protein, fat isn’t restricted to a specific subset of foods. Since fats are a key component of all cells, all foods contain some amount of fats. For example oats, hardly the first food you think about eating to get some fat in your diet, get about 16% of their calories from fat (1) while brown rice has about 8% of calories from fat (2). Even broccoli gets 10% of its calories from fat (3). So you will be getting some amount of fat if you are consuming whole foods.

    2. Hi Kate – I posted above on olives and olive oil but I thought I’d just share my olive info with you more directly. It takes about 44 olives to make 1Tbs of olive oil. Think about that – I don’t think I’d eat 44 olives with my salad. So you thought about crunching up a few olives directly will automatically lower your fat intake while still giving you that olive taste if that’s what you desire. My brother put a few in the blender with some water, vinegar, dijon mustard and spices and makes himself a nice dressing that way.
      Another thing you might try is making sure you fast for 12 hrs every night. The body starts using belly fat beginning at 10 hrs. The fasting window allows your body to use up extra calories and ‘clean house’ so to speak. Check out Dr. Valter Longo’s fasting work on Youtube. I, too, needed to bring my fasting blood sugar down from 125 and it is now in normal range. I finish eating each night by 7 pm and don’t eat again until I am good and hungry. Sometimes that’s not until noon the next day. I give my body a change to really use up the calories. It took a while but it’s been very helpful to me. Good luck!

  11. In the Nutritional Investment Market to goal it to maximize nutrient returns for the fixed number of daily calories that each investor has to invest. The Nutritional Rating Agency examines individual calorie investment funds to identify good investment options. NRA analysts give AAA ratings to the whole fruit and whole vegetable funds and a AA rating to the nut, whole grain and starchy vegetable funds. Due to nutrient stipping, the agency gives a B rating to refined grain, but only because of outside enrichment. And due to an almost complete absence of any nutritional return, the agency has given a “junk food” rating to all refined sugars and oil funds.

    The agency has also rated different portfolios. Their analysis has shown that the Mediterranean nutritional portfolio does have a higher nutritional rate of return than some other portfolios such as the SAD portfolio, but analysis of the individual funds making up the Mediterranean portfolio shows that all the positive nutritional returns came from the fruit, vegetable and whole grain funds. The refined grains fund had a neutral rate of return. However analysts found that the Mediterranean portfolio has a very large exposure to the very poor performance oil funds especially the olive oil fund. If calorie investors were to eliminate the olive oil funds from the Mediterranean portfolio they would see an already good return increase substantially without the drag on returns from these “junk food” funds. We understand that some investors will wish to keep some of these poor performing but very traditional funds in their portfolio, but we strongly encourage all investors to minimize their exposure to these funds to minimize future risk.

      1. I read your references and have read many others as well and have found them misleading at best. @tom_goff:disqus did a nice job of deflating the studies you reference, but I will address the Nature article as representative of your evidence.

        From the abstract: Results: Those with the highest consumption of olive oil (greater than 13.5% of total calories, fourth quartile) consumed less cereal, baked goods, whole milk, sausages, candy, fruit juice and soft drinks, but more fish, eggs, vegetables and added fats, as compared to those with the lowest olive oil consumption (less than 6.8% of total calories, first quartile). The group with the greatest olive oil consumption also demonstrated high total fat intake, although saturated fats showed a lower percentage of total energy intake. Vitamin intake was more adequate in those with the highest consumption of olive oil.

        Conclusion: Olive oil is a key contributor to the healthy aspects attributed to the Mediterranean diet, and as such, nutritional objectives in Mediterranean countries should address reducing saturated fats, without modifying quantities of olive oil.

        Let’s unpack this a bit. Basically people eating the most olive oil ate on the whole a healthier diet with less refined grains, saturated fat and refined or simple sugars and more vegetables. As such this study is a poster child for a study with the potential for confounding factors.

        Thus the conclusion that olive oil is responsible for the favorable health aspects of a “Mediterranean” diet is completely unsupportable. It is just as likely that it was the reduction of saturated fat that was the key factor even if it was replaced by olive oil and that any change in diet that reduced saturated fat would have shown similar or even better improvements. And there are so many other studies that show that the addition of more vegetables to one’s diet has a very powerful positive effect, and so it is also more likely that it was the higher vegetable consumption that was responsible for the positive health effects. Olive oil consumption could just be a marker for an overall better diet.

        If these studies are the best proof that olive oil contributes to health, then support for a positive health effect of olive oil is very weak indeed.

        If you want to make a strong case for olive oil making an already healthy diet even healthier find a study where two groups ate an identical healthy diet very high in whole fruits, vegetables, legumes and grains (foods already well established as health promoting) with the only difference being that one group ate a very low fat (<15% of calories) diet with very little or no added oils and no olive oil and the other group adding olive oil to their base diet to increase fat consumption to something around 30% of calories (the current "low" fat value). To make room for the calories in the olive oil, that group would only reduce the amounts of the fruits, vegetables, legumes and grains they consume. In this case any improvement in health of the olive oil group could be directly attributed to the addition of olive oil to their diet.

        This might not be as impossible as it sounds. There are populations such as those in rural Africa and Asia which until recently ate a diet with little or no added oil, no olive oil at all, and very high levels of whole plant foods (greater than 90% of calories). The disease rates observed in these populations could be compared with subpopulations in the different Mediterranean diet studies who also consumed higher percentage calories from whole plant foods, similar levels of animal foods (5%-10% of calories), but who also added substantial amounts of olive oil to their diet. And it has to be a substantial amount of olive oil since if olive oil has a negative impact on health a small amount of it added to what is otherwise very healthy whole plant based diet might not exceed the body's threshold level to cope. And a substantial amount shouldn't be a problem if olive oil actually makes a positive contribution to health.

        Given the extremely low rates of heart disease and most other chronic diseases in Africans and Asians eating a traditional low fat whole plant based diet, my money is on olive oil being a net negative.

    1. I have thought of the analogy between WFPB and a diversified financial portfolio, but your analysis of the olive oil sector is brilliant. You put it all together way better than I ever could. Thank you.

  12. Good question from ‘guest’ addressing WFRunner down below….

    I think many people wonder about this—do we have to be all or nothing? Is pure WFPB vegan really the best way to go? And if fish MIGHT be the ‘best’ of the animal foods, is some still OK, or even beneficial? Does the fact that the healthiest cultures still consumed some, albeit a very small amount of animal foods, mean that that’s probably the best approach? Does the fact that we need to supplement with B12 mean that we actually should have small amounts of meat?

    Well, there are probably more questions than answers. And it’s unclear because we really don’t have super long term trials –and I’m talking 30 year experimental studies comparing people eating WFPB vegan vs 90% plant based with small amounts of animal foods or fish. We do have observational studies that show though that the fewer animals foods consumed, including fish, the better the health outcomes. ON the spectrum, the closer someone is to being vegan, the healthier they appear, and these studies tend to look at chronic disease. Sure their B12 levels or D levels might be low, but from the research we have so far, it doesn’t appear to hurt their risk of living healthier and longer, because they seem to be better off.

    Keep in mind that research in nutrition and ESPECIALLY WFPB nutrition is in its infancy. There are a lot more studies to do and all the observant people who watch Dr. Greger’s videos and comment often point out studies that should be done or have questions that might not yet have been addressed in a study. You’ll notice that in many of Dr. Greger’s videos he creates a narrative that puts the topic into context…he gives the history of the study on that particular subject and notes that to prove X there needs to be a study that looks at X…and there hadn’t been…’…..until NOW”… And then he describes a new study that gives us some important info on the topic at hand.

    But also keep in mind that when he points to this new enlightening study, that’s not necessarily the be all and end all because science has shown that research is evolutionary and there generally needs to be a consensus of lots of studies in different populations, and preferably experimental studies, if that’s even possible, to really understand. One study is generally not enough to prove anything, although it certainly helps point us in the right direction hopefully if it’s well conducted.

    But the question of whether its OK, or whether we should eat fish definitely is a common one. Just as with other animal foods, sure, there are beneficial macro and micronutrients in them. They are not without any benefit. But there are also inflammatory components in the animal foods that we may not want to ingest. And with fish, it might not only be the fish flesh itself, but the fact that we have contaminated our waters worldwide and when we eat fish we eat poison, too. Dr Greger has done many posts looking at the toxins found in fish. http://nutritionfacts.org/?fwp_search=fish&fwp_content_type=video

    Despite what might be ‘good’ in fish, in many cases the bad outweighs the good. And that’s why sometimes in an idyllic setting in the countryside you’ll see signs put of in parks by a beautiful lake warning people who fish not to eat the fish! How much is actually harmful is unclear but studies have shown that even people who eat sushi on a somewhat regular basis can have dangerously high levels of mercury in their blood. And then of course, if you eat keeping ethics in mind, fish are no less sentient than our farm animals. They feel pain, too. – nutrition professor and volunteer moderator, ‪ Martica Heaner, PhD‬‬‬‬‬‬‬

  13. Just out of curiosity – – We know that certain soils are low in nutrients (like Michigan being deficient of iodine) and others are very rich – – Could the soils in the Mediterranean area be an additional reason why the crops grown there might be super beneficial for the human body??

    1. That is a good thought, TruthSeeker, however check out the 3rd paragraph of Dr. G’s article. When the diet in the Mediterranean changed, the levels of heart disease “skyrocketed”. I doubt there would have been a sudden change in the quality of the soil that would outweigh the changed in diet of the population.

  14. Pritikin also say’s, There are only two fruits she and her colleagues at Pritikin caution against: avocados and coconuts.

    Avocados are problematic if weight loss is your goal. They’re high in fat and therefore dense with calories. Coconuts are high in heart-damaging saturated fat.

    1. Avocados are one of the healthiest fruits on the planet, eaten in moderation they need no caution against whatsoever. .
      If weight loss is your goal eat low sugar fruits every colour in vegetables and an avocado, of course I don’t expect anyone to be stuffing their faces, while eating quality avocados, they won’t need to.

  15. Those articles aren’t particularly convincing. I was expecting more given your rather scathing references to Esselstyn and the Pritikin Centre

    The first one, a “communication” to the EJCN, reports the findings of an observational study. Observational studies are notoriously prone to confounding. The second, a study in Rajasthan (!?) simply compared one oil (soy) with another (olive). The third is the Predimed study. This is possibly the most impressive of the three. It is certainly the best known. However, it is still only an observational study. It has a number of other problems.

    First, the study participants were on average obese, Second, almost half were diabetic, 82% had hypertension and over 70% had hypercholeserolemia. Third, most if not all of them were on (prescription) drugs of some kind. These are the sort of subjects, the saturated fat advocates also like to study (presumably for the exact same reason). This reason is that people with damaged metabolic and endocrine systems (like the subjects of the PREDIMED study) do not respond to fats or other nutrients in the same way that people of normal weight do. I have posted this extract before but it makes the point better than I can and it is worth re-reading:

    “Multiple mechanisms likely contribute to the altered plasma lipid responses to dietary changes in individuals with excess adiposity. The greater rate of hepatic cholesterol synthesis in obese individuals suppresses the expression of hepatic LDL receptors (LDLR), thereby reducing hepatic LDL uptake. Insulin resistance develops as a result of adipose-tissue induced inflammation, causing significant changes in enzymes necessary for normal lipid metabolism. In addition, the LDLR-mediated uptake in obesity is attenuated by alterations in neuroendocrine regulation of hormonal secretions (e.g. growth hormone, thyroid hormone, and cortisol) as well as the unique gut microbiota, the latter of which appears to affect lipid absorption.”
    http://advances.nutrition.org/content/2/3/261.full

    Consequently, it may be misleading to suggest that these PREDIMED associations and effects are relevant for people without metabolic syndrome or are generalisable to the rest of us.

    I thought that it was also somewhat concerning that in this study, with a mean follow-up of 4.8 years, baseline olive oil consumption was (nonsignificantly) associated with cardiovascukar events and all-cause mortality 9table 4). Some of the benefits were also identified after adjustment. The authors also note “We found a strong relationship between total olive oil consumption and the composite of cardiovascular major events,..”

    In view of these issues, I am very reluctant to conclude that this study unambiguously shows EVOO consumption is healthful. It certainly presents EVOO in a good light but then the study did receive some financial support from the Spanish olive oil industry.

      1. The fact that some components of olive oil may be healthful does not mean consuming olive oil is healthful. Whisky will boost your phenol concentrations too but that doesn’t prove that drinking whisky is a good idea.
        http://link.springer.com/article/10.1007/BF02258900

        Perhaps your connection to the olive oil industry prevents you from being fully objective about the effects of olive oil consumption? For example, olive oil has been observed to impair endothelial function
        http://www.sciencedirect.com/science/article/pii/S0735109700008962

        “The limited data available from dietary intervention studies suggested a beneficial effect of low-fat diets on vascular reactivity, which was strongest when the comparator diet was high in SFA, with a modest improvement in measures of vascular reactivity when high-fat, MUFA-rich diets were compared with SFA-rich diets. There was consistent evidence from the test meal studies that high-fat meals have a detrimental effect on postprandial vascular function. However, the evidence for the comparative effects of test meals rich in MUFA or n-6 PUFA with SFA on postprandial vascular function was limited and inconclusive”

        Perhaps in the interests of full disclosure, you should tell us exactly what your connection to the industry is?

        1. I am simply a discerning consumer who has at least bothered to seek out a real organic olive grove whose product you won’t find in a supermarket. .

          I am very interested to note your suspicious attitude simply because I chose to inform people of my choice so they could do their own research into a real product, the area and the people working diligently to produce a healthy product, unlike a large percentage of oils in EU and UK supermarkets. I have no connections to any industries. My interest is nutrition.

          1. In an earlier post (to Gatherer), you said you had a direct connection to a specific, named olive oil company. Now you say that you have no connections to the olive oil industry.

            1. I have a direct connection because I chose to find and source my olive oil from a bio diverse area whose tiny scale of production suited my discerning tastes. Most peole’s connection is the supermarket, mine was a personal choice because of the quality of practise, unlike most people who haven’t a clue where their EVOO comes from.
              You chose to infer that which I did not imply. Twisting someone’s discerning desire to seek out a proper source of oil into a “connection” to industry is laughable.

              1. Oh, come on, you yourself described it as a “direct connection” now you are indignantly saying that it is not a “connection”.
                Still, it is wonderful to know that you have discerning tastes.

                1. Twisting the truth again? Where do I claim it is not a connection? This is laughable.
                  So that you might grasp the situation, I’ll give you another chance to understand.
                  A direct connection for me, as already stated, means I was willing to seek out a small grove product whose background I thoroughly researched. You obviously don’t understand these kinds of connections with what you eat.
                  Your inference is myopic suspicion.
                  You are unable to know that I also only eat food from organic farmers markets with whom I also have a direct “connection” as I buy from the grower, just Like I do with my EVOO, it is a direct connection with food, but doesn’t as your suspicious mind implies, have to be a financial one.

                    1. Prove it and show where I say I have “no connections” or are you still faking it?
                      I have no financial interest other than paying for real food, that’s my connection.
                      Get it yet?

                    2. Is this truculent attitude every time somebody disagrees with or asks a question, really necessary? Just scroll up the page and your words are there – here’s a copy

                      “Andrew Tom Goff • 2 days ago
                      I am simply a discerning consumer who has at least bothered to seek out a real organic olive grove whose product you won’t find in a supermarket. .

                      I am very interested to note your suspicious attitude simply because I chose to inform people of my choice so they could do their own research into a real product, the area and the people working diligently to produce a healthy product, unlike a large percentage of oils in EU and UK supermarkets. I have no connections to any industries. My interest is nutrition.
                      • Reply•Share ›”

                    3. Are your endless reiterations, twisting what I have explained, really necessary,
                      So where does it say I am “connected” other than through my desires for a proper oil?
                      Absolutely nowhere! Here’s your original request below, like I am already guilty.

                      “Perhaps in the interests of full disclosure, you should tell us exactly what your connection to the industry is?” You see how the attitude is accusative?
                      Need to hear it all over again? My connection is a real oil. As if that is a crime!
                      Has the penny dropped yet, or are you going to ask again and again?

                  1. Andrew: I don’t know anyone (other than you) who would describe or understand a “direct connection” to a business as simply an informed purchaser. It’s odd to me that you did not respond by acknowledging the ambiguity in your post, thanking Tom for pointing it out, and then simply taking the opportunity to provide clarification. Done in one. It does no one any good to argue over semantics.
                    .
                    In future posts, consider using more common usage language or using more words to be more explicit to describe your relationships with businesses. That will prevent a lot of wasted time on everyone’s part. There is no point in going and on and on about what the words “direct connection” must mean. This point is for Tom also. Let’s let it go!

                    1. Thank you Thea but I am not interested in anyone’s knee jerk reactions to my direct connections to real foods of any kind.

                      The inference was that I had an interest outside of food quality, which having explained was not true, was still demonised with a myopic suspicious attitude that is still prevalent.

                      When that suspicion is no longer prevelant, I will let it go.

                      The fact that you don’t know anyone who describes a direct connection to an olive oil grove as a food interest, doesn’t surprise me, most people consume rubbish olive oil.
                      I wasn’t asked for clarification, I was guilty before the court of Tom by his quip below.

                      Quoting Tom “Perhaps in the interests of full disclosure, you should tell us exactly what your connection to the industry is?” Already guilty!!
                      Every explanation has been countered with myopic suspicion. And you want me to thank him? For what, his suspicions?

                    2. The point is that Tom had the same question I had after reading your post: Please disclose what exactly is your connection to the industry? Tom did not have a knee jerk reaction. You did. Time to stop or as a moderator, I will have to step in.

                    3. It was stated that “in the interests of full disclosure, you should tell us exactly what your connection to the industry is?” And I thought it was innocent until proven guilty!
                      My post was regarding due diligence to a real oil, disclosure is some legal jargon when someone is accused of having an interest over and beyond an innocent post.
                      I am defending real EVOO where the responders were slagging it off.
                      The attitude that I need to “disclose” is accusative and distasteful.
                      No wonder I want to defend my position.
                      Do whatever you have to.

        2. Tom: This conversation was getting distracting and silly. I deleted several posts from both of you. I let Andrew’s original reply to you stand as the last word since Andrew clarifies that he does not in fact have a “direct connection” as he originally claimed – at least not how most people would interpret that phrase. Andrews says he is a “discerning customer”.
          .
          To be fair to you, though, I am going to make it very clear why you logically wrote, “Perhaps in the interests of full disclosure, you should tell us exactly what your connection to the industry is?”
          .
          Here is Andrew’s original claim in a post to someone else: “I have a direct connection with a small olive oil grove run by six dedicated men and their family. … ” from: http://nutritionfacts.org/2017/01/03/whats-the-mediterranean-diets-secret/#comment-3082292230
          .
          And now I declare this conversation over. Any new posts about what “direct connection” means will be deleted.

          1. I am very disappointed that you removed a reasonably polite reply to another unpleasant post from Andrew.

            I don’t see any equivalency between his remarks and mine. But that’s your prerogative.

            Goodbye.

            1. Tom Goff: I’m sorry to disappoint. I don’t like deleting comments and don’t do lightly. I’m sure I make mistakes. I just do the best I can in each situation.

  16. I’d like to see a discussion on the value of fats (and oils vs. actual whole food sources) (olives vs. olive oil and coconut vs. coconut oil) between some of the experts. And the proportion of fat in the diet that is recommended. I would personally like to see a panel discussion with Michael Gregor, Daniel Amen & Mark Hyman.

    1. That would be great, but only if all panelists had to present slides showing how the diet they recommend was able to reverse diabetes, high blood pressure, and heart disease in for what percentage of subjects consuming it. And each panelists would have to prepare a slide showing how the diet they recommend compares to each other diets for disease prevention and reversal. This wouldn’t be entirely fair since Dr. Greger already has his presentation pretty much ready to go. I for one would find it very interesting to see how these other doctors justify recommending their diet if they had to put hard numbers up on a screen and also had to compare it to a WFPB diet and not just shooting fish in a barrel by comparing it to the SAD.

    2. Let me suggest, also, that if you were to set up your panel, that Dean Ornish, M.D., and Caldwell Esselstyn, M.D. be included. Both have been able to show scientifically and with proper testing of patients the reversal of heart disease. Ornish’s science is so excellent that Medicare now pays for Ornish’s heart disease reversal program. A fact that few people know at the moment.
      Let me also share with you that it takes about 44 olives to make 1 TBS of olive oil; approximately 1/2 coconut to make the same. Think about eating 44 olives or 1/2 coconut with your salad (and that’s if you only put 1 Tbs of oil on your salad).
      And for those whose argument is that “we need fats to assimilate our vitamins from vegetables”, let me share with you that all vegetables have fat in them. Broccoli is 10% fat, asparagus 5% fat, spiinach 14% fat. You can look up your own vegetables of interest here:
      http://nutritiondata.self.com/facts/vegetables-and-vegetable-products/2626/2
      You don’t see rhinocerous’, giraffes, gorillas, antelopes, deer, elk, whales, rabbits, elephants, etc. (you get the idea) running around trying to find olive oil to slather on the vegetable matter that they eat. They get plenty of natural fat in the vegetation that they consume their entire lives.
      Let me share what my brother does if he’s feeling like a little olive taste with his salad – he takes a few olives (depending on how many are consuming the salad), rinses the salty brine off, and throw ’em in the bullet blender with some garlic, vinegar, perhaps a little dijon mustard and some spices and makes himself a salad dressing with the real thing. Then you don’t have to worry about getting oil from some distant country and if it’s the real thing or not. You also don’t eat the fat of 44 olives in one sitting. Give it a try and if you come up with a scrumptious recipe share it here. Same thing with sauteeing . ..blend the olives with some water and use that. 3 olives oughta do the job I would think.

      Don’t ya just love how the food industry confuses the pubic? Ya, . . me too.

  17. Food for thought for the EVOO lovers …

    “Your Olive Oil Is Almost Certainly Fake”
    http://www.motherjones.com/environment/2016/08/olive-oil-fake-larry-olmsted-food-fraud-usda

    Excerpts:
    “Food fraud—or the act of deceiving consumers about a food or ingredient for the sake of profit—affects as much as 10 percent of the global food supply. Of all the instances of food fraud in the United States, according to a scholarly database tracking this very thing, olive oil leads the way, making up 16 percent of cases (followed by milk, honey, saffron, and orange juice).”

    “Since extra-virgin olive oil is the most valuable oil category in the United States, shady producers and dealers have plenty of incentive to mess with it in hopes of reaping more profit. They defraud consumers in three main ways: by (1) diluting real extra-virgin olive oil with less expensive oils, like soybean or sunflower oil; (2) diluting high-quality olive oil with low-quality olive oil; or (3) making low-quality extra-virgin olive oil, “typically incorporating older—and often rancid—stocks of oil held over from bumper crops of previous seasons,” writes Olmsted. When the University of California–Davis researchers tested olive oil bought off the shelf in 2010, they found that 69 percent of imported “extra-virgin” samples failed to meet international standards.”

    There are some tips for increasing your chances of buying real, fresh EVOO.

    1. I have a direct connection with a small olive oil grove run by six dedicated men and their family. It is an organic farm and the bio-diversity is second to none. The company Dehesa de La Sabina has won two gold and one silver at the world renowned New York Olive Oil Times competition.
      If you don’t source any foods you buy properly you are likely to be eating toxic material and you may as well be talking about any food in your post. The fraud in Olive Oil is legendary and nothing new at all, it has been going on for decades. As for your comment not endorsing REAL EVOO, mine is endorsing it as do many science based peer reviewed scholarly articles.

      1. Andrew, it is always important to follow the money. The studies endorsing EVOO that I have been able to find are either funded/supported by a company that makes olive oil or by an economic development authority for a region which produces a lot of olive oil.

        As I asked in another comment, do you have any studies that were not funded by those with an economic interest in the results AND in which the olive oil was not simply replacing other less healthy fats? Specifically do you have any study where olive oil was added to an otherwise very healthy diet (80%-90% of calories from whole plant foods) and the health of those eating olive oil was better compared to those who were still eating the healthy diet but without the added olive oil.

  18. As I also read other articles that talk about mediterranean diet, pasta has been previously dismissed from this diet because it is believed that it contributes to weight gain. However, new research says that consumption of pasta is not associated with an increase in body weight as the data showed that enjoying pasta according to individuals’ needs, contributes to a healthy body mass index, lower waist circumference, and better waist-hip ratio. Personally, as pasta lover, that is definitely good news!

    1. I would not get too excited about this.

      The raw data from this study showed that “Both in women and men, the obese population was older and at lower socioeconomic status (P for all<0.001), had higher waist and hip circumferences and waist-to-hip ratio, and consumed more pasta (grams per day) than normal or overweight participants (P for both<0.05)' for the Moli-sani population.

      In the second population studied: "Similarly to the Moli-sani dataset, both female and male obese were older (P for both<0.001), at lower socioeconomic status and reported a higher intake (grams per day) of pasta in women (P=0.002)."

      The authors consequently had to "correct" the original, reported data to generate a result which showed that pasta is negatively associated with BMI etc.

      Purely coincidentally, the study was funded by an Italian food company (that just happens to sell pasta) and the Italian Ministry of Economic Development..

      http://www.nature.com/nutd/journal/v6/n7/full/nutd201620a.html

  19. And what about tomatoes in a can. It’s just tomatoes in the juice. I know that fresh is the best but sometimes for convince (and usually they are cheaper) is just easier to use them instead of not using veggies at all..

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