Extra virgin olive oil, the darling of the top-rated Mediterranean diet, not only imparts a silky lusciousness to foods, but has emerged as a superfood in scientific studies. Research published in the New England Journal of Medicine, The BMJ and The Journal of American College of Cardiology all link increased extra virgin olive oil consumption with reduced risk of cardiovascular disease and other major maladies. The Food and Drug Administration recommends two tablespoons per day for health benefits.
So, we should pour it on, right?
Not so fast, according to Dr. Caldwell Esselstyn, a cardiovascular surgeon and author of the 2008 book ”Prevent and Reverse Heart Disease.” Esselstyn, who was featured in the documentary ”Forks Over Knives,” has prescribed an oil-free, whole-food, plant-based diet for patients with severe heart disease.
And whether you call it a whole-food, plant-based diet, WFPB, or a “Forks Over Knives” diet, Esselstyn is adamant: “No oil.” Consuming oil, he asserts — even extra virgin olive oil — damages the endothelial cells regulating blood flow.
You want healthy, happy endothelial cells? Give up oil, Esselstyn believes.
So who’s right?
Here’s why Esselstyn suggests avoiding oil
Esselstyn isn’t banning oil to be a killjoy. He’s basing it on a 1990 study, as well as his own findings published in a journal article titled “A Way to Reverse CAD” (coronary artery disease). Both studies found that oil consumption reduces flow-mediated vasodilation — doc talk for slowing blood flow.
Oil-free is not the same as fat-free. Fat is one of the macronutrients our bodies need for optimal function, and Esselstyn isn’t suggesting cutting out all fats. Instead, Esselstyn and his peers, including Dr. Dean Ornish and Dr. T. Colin Campbell, say fats should come from whole foods that are rich in healthy fats, like avocado, nuts and seeds. That gives you both fat and beneficial dietary fiber.
“Fiber helps us regulate digestion and absorption,” nutritionist Jay Ziebart said. Most Americans fall woefully short of getting the U.S. Department of Agriculture’s recommended daily allowance of fiber.
No one’s disputing olive oil’s rich flavor. Some oil-free advocates even say that’s the problem — that olive oil makes food taste so good it encourages overeating. Numerous studies contradict that, suggesting a little olive oil helps you feel full.
Ziebart said that for her clients, “most of whom have been struggling for many years to lose weight and take back their health, oil is just not worth it.”
Ziebart and “Forks Over Knives” offer easy swaps. Water or vegetable broth replace olive oil in cooking, even sautéing, and applesauce or mashed banana are substitutes in baking. They offer recipes, including oil-free lasagna. Not appealing? Neither is heart surgery, Esselstyn would argue. Health is one of the main reasons people embrace oil-free WFPB eating.
Here’s where the Mediterranean diet and “Forks Over Knives” tribes agree
Both camps believe that processed food does your body no favors. The healthiest foods are minimally processed whole foods — produce, beans, whole grains, nuts and seeds.
Oil of any kind is calorie-rich, coming in at around 120 calories per tablespoon. So, if you must use oil, extra virgin olive oil — a monounsaturated fat — outperforms all others in terms of health benefits. Yes, coconut fans, it’s even better than coconut oil.
As Connie Diekman, nutritionist and author of “The Everything Mediterranean Diet Book” explained: “Coconut oil is not a healthful oil because of its saturated fat content.”
The benefits of olive oil
Diekman and other Mediterranean diet proponents don’t argue about olive oil’s calories. They point to something so positive it makes the calories worth it — polyphenols.
“They’re the most important thing you eat you’ve never heard of,” said Dr. Simon Poole, author of “The Olive Oil Diet” and “The Real Mediterranean Diet.” Polyphenols are plant compounds with “unique properties,” he said.
“In our bodies, they serve as antioxidants, as anti-inflammatory,” Poole explained. And extra virgin olive oil is loaded with them.
Fun fact: Olives are fruit, botanically speaking. Extra virgin olive oil is made from crushed olives, minimally processed, so you’re basically getting pure fruit juice with pure — and potent — olive flavor. That’s a good thing. Extra virgin olive oil is high in antioxidants and polyphenols.
“You can taste polyphenols in olive oil,” Poole said. “It’s that slightly bitter, peppery and pungent quality valued by tasters.”
One of the highest polyphenol olive oils, Olio Piro from Tuscany, has garnered over 20 awards, including the 2021 Flos Olei best in the category of blended, medium-fruity, extra virgin olive oil. The olives are hand-picked to prevent bruising and are crushed the day they’re harvested, keeping the nutrients intact. While most supermarket brands contain anywhere from 20 milligrams to 100 mg of polyphenols per kilogram, Olio Piro tops out at 700 mg.
Olio Piro producer Romain Piro, his wife Livia, and their two children consume about 50 liters of extra virgin oil each year.
Exactly how our bodies metabolize polyphenols and how polyphenols interact with other plant nutrients is still being studied. But if the Piros are any indication, all those polyphenols are doing something right. The family is the picture of glowing good health — the best ad for their product.
Esselstyn, who’s spent years on a WFPB oil-free diet, is looking pretty terrific, too. And he’s 88.
Both diets make good cases, so should we call it a truce?
Poole said there are good grounds for peace. “We need to be finding what we can jointly say is good about diets,” he said. “We need to talk about positive nutrition.”
So, can’t we just focus on areas where WFPB and the Mediterranean diets agree? Whole foods are good for us, and the olive oil issue is still up for debate.
Esselstyn, though, resists pouring olive oil over troubled water. “When you take patients seriously ill with cardiovascular disease and get them on a whole-food, plant-based diet without oil, not only do they halt disease, they reverse it,” he said. “Not a single study with oil I’m aware of does that. I stick with what we said.”
Poole, the Piros and the Mediterranean diet tribe will stick with olive oil. “You can’t take extra virgin olive oil out of the Mediterranean diet,” Poole said.
Perhaps they’re both right. There’s no one do-it-all diet for everyone, Diekman pointed out. “It’s about you as an individual knowing your health risk, and finding a healthful eating pattern you can maintain.”