What does an inter­ven­tional car­di­ol­o­gist have to do with olive oil?

The usual day of an inter­ven­tional car­di­ol­o­gist in the cath lab is most likely to include cases of coro­nary artery dis­ease, either in its acute form (“acute coro­nary syn­dromes” that is, heart attacks or unsta­ble angina) or in its chronic form (chronic sta­ble angina). The inter­ven­tional car­di­ol­o­gist uses per­cu­ta­neous pro­ce­dures, like bal­loon angio­plas­ties and stents, along with a host of med­ica­tions to open clogged coro­nary  arter­ies. In no heart pro­ce­dures is olive oil used!

Then what is the olive oil con­nec­tion? The story of dis­eased heart arter­ies starts a few decades before the inter­ven­tional car­di­ol­o­gist is called upon to per­form any pro­ce­dures. What starts the artery dis­ease is usu­ally either smok­ing or an abnor­mal metab­o­lism. It is the abnor­mal metab­o­lism that leads to heart dis­ease than can be sig­nif­i­cantly affected by olive oil.

Olive oil can reduce the risk of heart attacks and stroke.- Antonis Pothoulaki

In our thir­ties and for­ties many of us, exposed to the west­ern lifestyle (lim­ited phys­i­cal activ­ity, processed and fast food loaded with salt and sat­u­rated and trans fats, and high-​glycemic index snacks such as cook­ies, desserts, can­dies) har­bor shal­low cho­les­terol plaques in our coro­nary arter­ies. The slow time line of “ath­er­o­scle­ro­sis” (cho­les­terol plaque buildup in the wall of the arter­ies) can be sud­denly and unpre­dictably punc­tu­ated by a “cri­sis” caused by an insta­bil­ity of the plaque.  Either a “crack” or “fis­sure” forms on its sur­face or a small “bleed” takes place inside the plaque. The unsta­ble plaque then prompts the flow­ing blood to form a clot at the plaque site because the blood inter­prets the unsta­ble plaque sit­u­a­tion as “bleed­ing” and it responds the way it is pro­grammed to: by form­ing a clot.

What is truly dra­matic is the time line of clot for­ma­tion (“throm­bo­sis”): it takes between one and four min­utes for a clot to form inside the artery and trans­form a pre­vi­ously sta­ble plaque that was caus­ing lit­tle or no nar­row­ing of the artery lumen to now become 100% occlu­sive. This stops the flow of blood and the nour­ish­ment of the heart or brain cells that depend on that artery abruptly ceases. The cells, then, start dying fast, result­ing in a heart attack, a stroke, or sud­den death. Prime risk fac­tors for both plaque devel­op­ment (ath­er­o­scle­ro­sis) and plaque insta­bil­ity with clot for­ma­tion (atherothrom­bo­sis) are:

•  Smoking
•  Metabolic Syndrome
•  Genetic pro­file
•  Aging process

While we can do noth­ing to coun­ter­act our hered­ity or our age we can do a lot to stop the other two “killers”: smok­ing and meta­bolic syn­drome. Whereas olive oil (and the other fea­tures of the so called “Mediterranean diet” or “Mediterranean lifestyle”) is strongly con­nected with the health of our metab­o­lism it has no smok­ing ces­sa­tion prop­er­ties, to my knowl­edge.

The Metabolic Syndrome is a com­bi­na­tion of abdom­i­nal obe­sity (also called “vis­ceral obe­sity”, “cen­tral obe­sity”, “apple-​shape” body, or “beer belly”) along with abnor­mal cho­les­terol, abnor­mal sugar metab­o­lism (pre-​diabetes or type 2 dia­betes), and high blood pres­sure (“hyper­ten­sion”). It is seden­tary lifestyle and an unhealthy diet that lead to meta­bolic syn­drome. A diet is unhealthy if it con­tains:

•  Too many calo­ries
•  Too much salt
•  Unhealthy fats (sat­u­rated and trans-​fats)
•  High-​glycemic index car­bo­hy­drates

A healthy diet, on the other hand, along with reg­u­lar and ade­quate exer­cise, helps pre­vent or, at least, atten­u­ate, the meta­bolic syn­drome and atherothrom­bo­sis (heart attacks and strokes). A healthy diet is not only about what not to con­tain (the four cat­e­gories listed above) but also about what should be included every day:

•  At least five por­tions of fruits and veg­eta­bles
•  Whole grains
•  Omega-​three PUFAs (polyun­sat­u­rated fatty acids found in oily fish salmon, sar­dines, mack­erel)
•  MUFAs (mono-​unsaturated fatty acids found in olive oil, olives,avocado,nuts, dark choco­late)

Three quar­ters of olive oil con­sists of MUFAs (mainly oleic acid) with the rest almost equally divided between PUFAs and sat­u­rated fats. MUFAs are very ben­e­fi­cial for our health because they:

•  reduce LDL-​the “bad”-cholesterol lev­els in the blood
•  “dis­place” sat­u­rated fats from the diet
•  con­tribute to sati­ety (make us feel full with less amount of food)
•  delay the absorp­tion of the rest of our food, pre­vent­ing fast absorp­tion of high-​glycemic index car­bo­hy­drates and, thus, pre­vents insulin spikes and pre­ma­ture hunger
•  increase adiponectin, a hor­mone that pro­motes the “burn­ing” of body fat for energy pro­duc­tion
•  con­tain addi­tional ben­e­fi­cial sub­stances (antiox­i­dants and phy­to­chem­i­cals)

In par­tic­u­lar, olive oil has:

•  the high­est con­tent of MUFAs, as com­pared to other veg­etable oils or nuts
•  the higher oxi­da­tion thresh­old, so when used in deep-​frying is less likely than any other veg­etable oil to become par­tially hydro­genated (trans­formed to the “poi­so­nous” trans-​fats), and it
•  con­tains a host of antiox­i­dant phy­to­chem­i­cals like polyphe­nols (tyrosol), squa­lene, carotenoids, and vit­a­min E

Olive oil con­tains almost no sodium (salt) and car­ries about 9 calo­ries per gram.

Metabolic syn­drome and atherothrom­bo­sis (heart attacks, strokes, or sud­den death) are more likely to occur when our body bal­ance is shifted towards inflam­ma­tion (proin­flam­ma­tory) and clot for­ma­tion (pro­throm­botic). Olive oil helps coun­ter­act both mor­bid states by virtue of its MUFAs and antiox­i­dant con­tent. Furthermore, antiox­i­dants and oleo­can­thal coun­ter­act the neu­ro­toxic effect of the ADDL pro­teins involved in Alzheimer’s dis­ease. Olive oil also appears to have an anti-​aging effect and reduce the risk of cer­tain can­cers includ­ing breast, pan­cre­atic, stom­ach, laryn­geal, and uri­nary tract can­cer.

Health ben­e­fits of olive oil in spe­cific dis­eases

Hypertension
A diet high in unsat­u­rated fatty acids reduces blood pres­sure as com­pared to a diet rich in sat­u­rated fat. Among unsat­u­rated fats it appears that both monoun­sat­u­rated fatty acids (like those con­tained in olive oil) and polyun­sat­u­rated fatty acids (found in fish and other veg­etable oils) lower blood pres­sure. An Italian research in patients with known hyper­ten­sion has shown that con­sump­tions of 40 gm of olive oil a day reduces blood pres­sure by about 50% (almost half of the patients were able to reduce the dose or stop tak­ing alto­gether their blood pres­sure med­ica­tions). The ben­e­fi­cial effect of olive oil (espe­cially the extra vir­gin olive oil) is attrib­uted mainly to its polyphe­nols.

Cardiovascular dis­ease (ath­er­o­scle­ro­sis and atherothrom­bo­sis)

High LDL cho­les­terol con­tributes to ath­er­o­scle­ro­sis and atherothrom­bo­sis, deposit­ing cho­les­terol in the artery wall and clog­ging the arter­ies of vital organs (like the heart, brain, and kid­neys). HDL cho­les­terol is the “good” cho­les­terol and acts as a scav­enger, remov­ing cho­les­terol from plaques in the artery wall. Reducing LDL cho­les­terol and rais­ing HDL cho­les­terol has sig­nif­i­cant health ben­e­fits and pro­tects against heart attacks, strokes, and sud­den death. Consumption of about two table spoons of olive oil reduced LDL (the “bad” cho­les­terol) and mildly raise HDL (the “good” cho­les­terol).

Beyond a favorite effect on LDL and HDL lev­els, olive oil has two more ben­e­fits that reduce heart attacks and stroke:

•  It pre­vents oxi­diza­tion of LDL which ren­ders it more athero­genic than its non-​oxidized form. This ben­e­fi­cial effect of olive oil on lipids is medi­ated through its antiox­i­dant com­po­nents, espe­cially polyphe­nols and vit­a­min E.

•  It reduces the chance of “throm­bo­sis” (clot for­ma­tion) in arter­ies by reduc­ing fac­tors that either cause clot­ting (plasma fac­tor VII) or inhibit break-​down of clots already formed (plas­mino­gen acti­vat­ing inhibitor)

Type 2 dia­betes and meta­bolic syn­drome

Olive oil reduces the meta­bolic com­pli­ca­tions of type 2 dia­betes and meta­bolic syn­drome. With its polyphe­nols and squa­lene com­po­nents it reduces the high level of inflam­ma­tory activ­ity present in both dia­betes and meta­bolic syn­drome. Thus, olive oil helps reduce LDL-​the “bad”-cholesterol, lipid oxi­da­tion and high blood pres­sure. A diet rich in olive oil also facil­i­tates glycemic con­trol by leav­ing “less room” for car­bo­hy­drates (par­tic­u­larly “sim­ple sug­ars” that cause insulin spikes and pre­ma­ture hunger attacks).

Alzheimer’s dis­ease

Inflammation and free rad­i­cals dam­age brain cells and impair synap­tic func­tion, con­tribut­ing to the neu­rode­ge­na­ra­tion and brain cell loss that char­ac­ter­izes Alzheimer’s dis­ease. The squa­lene con­tent of olive oils (along with its other antiox­i­dants) has neu­ro­pro­tec­tive effects and does not allow oxi­da­tion of its monoun­sat­u­rated fatty acids (which unfor­tu­nately occurs with polyun­sat­u­rated fats that may, thus, con­tribute to nerve dam­age). Oleocanthal, another olive oil com­po­nent has been shown in sci­en­tific research to slow down the pro­gres­sion of Alzheimer’s.

Aging and longevity

Free rad­i­cals attack and dam­age cells and its con­stituents, espe­cially DNA found not only in the cell nucleus but also in the mito­chon­dria. It is hypoth­e­sized that olive oil with its antiox­i­dant effects inhibit per­ox­i­da­tion and reduces mito­chon­dr­ial DNA dam­age, pre­serv­ing vital­ity and youth­ful­ness. It appears that the oleo­can­thal com­po­nent of olive oil sig­nif­i­cantly con­tributes to olive oil’s anti-​aging effects. There is a report of a 120-​year-​old Israeli woman who used to drink a glass of olive oil every day!

.
Antonis Pothoulakis, MD, FACC
Interventional Cardiologist
“Iasis” Clinic, Markou Botsari 76 – 78
Chania 73100, Crete, Greece


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