1. Extra Virgin Olive Oil let food be thy medicine … Mary M. Flynn, PhD, RD, LDN The Miriam Hospital and Brown University, Providence, RI October 2015

2. Epidemiology Lower rate of heart disease and cancers in countries consuming a traditional Mediterranean diet plant-based (vegetables, fruits, grains) extra virgin olive oil red wine Seven Country Study Meddiet Score – using ratio MFA:SFA in the diet [Flynn: not useful] Extra virgin olive oil – key component of the Mediterranean diet

3. Risk factors for chronic diseases that diet can change excessive oxidation lipids (cholesterol, triglycerides) and lipoproteins (HDL, LDL) blood pressure blood levels of glucose and insulin inflammation cancer: initiation, promotion, progression (to tumor)

4. Plant products Phytonutrients all plants have them (variety) protect plant from the environment health properties in humans → related to decreasing risk factors for chronic diseases

5. Extra virgin olive oil Juice of the olive phenol content – responsible for health benefits expressed as: mg/kg. [Flynn guidelines] refined: < 20 mg/kg low: up to + 190 mg/kg medium: 200-400 mg/kg high: > 400 mg/dl Depends on: olive, growing/ harvesting conditions Many of these phenols are exclusive to olives

6. Oxidation Excess oxidation: initiates and promotes cancer (DNA, membranes) makes an LDL particle that contributes to atherosclerosis Oxidation is promoted with polyunsaturated fats found in: vegetable seed oils, red meat, fish oils Olive oil: primarily monounsaturated fat highest content of alpha tocopherol (vitamin E) high phenolic content decreases LDL, DNA oxidation

7. Blood lipids/ lipoproteins LDL: level is not as important as oxidation Compared to vegetable seed oil (high in polyunsaturated fats): extra virgin olive oil may or may not decrease Phenolic content: some evidence higher phenolic may lower LDL Linear increase in HDL with increasing phenolic content

8. Blood pressure Compared to sunflower oil: 2 to 3 tablespoons/day of EVoo for 6 months: significant decrease in systolic and diastolic 4 tablespoons of EVoo /day 4 weeks (84 yrs): decrease in systolic BP

9. Blood pressure Phenolic content: men (161 mg/kg v refined) at 3 tablespoons/day of EVoo for 3 weeks: lowered systolic BP Women (564 mg/kg v refined) at 4 tablespoons/day of EVoo for 8 weeks lowered systolic and diastolic

10. Blood levels of insulin and glucose Higher (but within normal range) levels related to: increase risk of heart disease and cancers (breast, prostate, colon, leukemia) 3 tablespoons/ day EVoo for 2 weeks v sunflower oil: significant decrease in fasting glucose and insulin Olive oil enriched diet v vegetable oils for 8 weeks: improved insulin sensitivity (need less insulin) Pasta and eggplant fried in olive oil 2 tablespoons lead to lower blood glucose and insulin v just adding olive oil

11. Inflammation Response to disease, level of disease Oleocanthal – inhibits COX 2 enzyme COX2 leads to inflammatory pathway same action as ibuprofen (NSAID)

12. Olive oil and cancer protection Squalene – found in all olive oil tumor inhibitor decreases cancer risk Most of squalene to the skin → UV protection Oleuropein (in test tube) inhibited cancer cell invasion and regressed tumors

13. Vegetables and olive oil Carotenoids – give pigment to vegetables powerful cancer fighting properties in the body ** need dietary fat to absorb ** cooking in fat increases absorption Glucosinolates – cruciferous family (cauliflower, cabbage, broccoli, Brussel sprouts, kale) cancer protective, especially breast and prostate ** water soluble, preserved with fat Makes vegetables taste better, increases intake

14. Body weight Inverse relationship Mediterranean diet adherence and body mass index (BMI) in Spain and Greece SUN Study (Spain): higher baseline consumption of olive oil reported, lower likelihood of gaining weight (not significant, but a trend) Related to smaller waist circumference

15. Plant-based, olive oil diet (PBOO) Per day: > 3 tablespoons extra virgin olive oil (high quality) unlimited vegetables and Salad (minimum of 4 servings) 1 serving = ½ cup of vegetables or 1 cup of greens (salad) 3- 4 servings of fruit 1 serving = ½ cup or ½ piece of fruit 6 to 8 servings of starch (emphasis on whole grains) 1 serving = 1 oz. dry weight eggs and dairy included limited poultry or seafood; no red meat

16. Cost of olive oil Consider at price per tablespoon Should be an “every day food” Benefits start at 2 tablespoons / day Flynn: 1 tablespoon EVoo per cup of vegetables Can use to cook

17. Flynn research with EVoo Women with invasive breast cancer compared to a lower fat diet, plant-based EVoo diet: better weight loss and acceptability lower triglycerides and higher HDL Men with recurrent prostate cancer and metabolic syndrome: 8 weeks of diet led to mean weight loss of 6% (BMI: 32.5 to 30.5; p<0.05) decrease in glucose and insulin

18. Flynn research with Evoo, cont. 6 week cooking program for food pantry clients goal of 2 to 3 main meals a week using EVoo recipes Significant decreases in: purchases of meat, carbonated beverages, desserts, snacks and total groceries ($68 to $37/week) Food Insecurity – less hunger Body mass index (BMI) and waist size Significant increases in: total number and variety of fruits and vegetables

19. McAuley House – “Healing Food Project” 6-week cooking program for type 2 diabetics 10 completed: 15% decrease in blood glucose trend towards weight loss, diet improvement “Food is Medicine” – to educate current and future health professionals how food can be used as medicine. cooking program for type 2 DM 6 months of food from food pantry

20. Conclusions: Consistent use of 2 tablespoons per day of extra virgin olive oil will: improve health by lowering oxidation, inflammation, blood pressure, and blood glucose and insulin improve health and level of blood lipids (LDL, HDL) lowering body weight and decrease risk of weight gain lower food costs and improve diet (likely increase vegetable intake)