Olive Oil_Fact Sheet 06

Olive Oil and the Gastrointestinal Tract

Introduction
From an increasing number of publications, it is becoming more and more evident,
that the quality of dietary fat influences physiology and pathophysiology of the
gastrointestinal tract. The main focus of these studies has been the effect of different
dietary fatty acids on gastric acid secretion and gallstone formation. Diseases of the
stomach and in particular gallstones are very common in western industrialised
countries, e.g. the prevalence of gallstone disease is up to 38% in Europe and North
America (4).
Gastric acid secretion
In 1886, in what was probably the first study to investigate the influence of dietary
fat on gastric function, Ewald and Boas observed that the addition of olive oil to a
test meal suppressed gastric acid secretion (6). Since then, numerous studies have
confirmed, that the presence of fat in different segments of the intestinal tract inhibits
gastric acid secretion. In most of these studies olive oil was used as a source of
dietary fat. The intraduodenal presence of olive oil reduces gastric acid secretion in
dogs (11), rats (20) and humans (18, 23). However, until recently it was unknown,
whether this effect was also verifiable for other dietary fats, or if it was a specific
feature of olive oil or monounsaturated fatty acids. In 1997, Serrano et al. compared
the effects of diets rich in monounsaturated fatty acids (olive oil) with diets rich in
polyunsaturated fatty acids (sunflower oil) on gastric acid secretion. They were able
to show, that "a 30-day period of diets containing olive oil [ ...] resulted in attenuated
gastric acid secretion in response to a liquid meal when compared with those
containing sunflower oil" (22). Rhee et al. (20) also investigated the mechanical
aspects of this suppressive action of oleic acid. They were able to show in rats, that
the inhibitory effect of oleic acid on gastric acid secretion is mediated by a peptidic
hormone released into the blood when the duodenal mucosa comes into contact with
this fatty acid.
These findings consistently indicate that the consumption of olive oil reduces gastric
acid secretion. This effect might be beneficial with regard to diseases such as gastric
or duodenal ulcers, where the attenuation of gastric acid secretion is a key therapeutic
goal.
Gallstone formation
There are numerous investigations into the relationship between diet and the
formation of gallstones. Unfortunately, in some of these studies (9, 10, 15, 17, 19, 21,
25), the dietary fatty acid composition has not been determined, so these studies do
not allow an evaluation of the relationship between gallstones and dietary fatty acids.
Furthermore, wide variations in study design, methods of diet assessment or
diagnosis of gallstone disease make a comparison of the studies on this topic rather
difficult.
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One of the first investigations describing a relationship between dietary fat and
gallstone disease was a case-control study by Linos and colleagues in 1989. In their
study they found that "from all the dietary factors the only one that showed a positive
statistically significant (p<0.05) association was consumption of animal fat [ ...] .
Interestingly high consumption of olive oil had a negative (i.e. protective) association
with the disease" (12). Recently Misciagna and colleagues observed in a populationbased case-control study that among other factors, saturated fats were a risk factor for
gallstone formation while dietary monounsaturated fatty acids were inversely
associated with this disease (14). In a prospective study, Gilat et al. observed a higher
intake of energy, carbohydrates, fibre and unsaturated fatty acids in Arabs who had a
low incidence of gallstones compared to Jews with a higher incidence of the disease
(7). However, they concluded that "it cannot be determined which, if any, of these
dietary differences is related to the lower frequency of gallstones". Further evidence
of an association between the quality of dietary fat and gallstone formation is
provided by a finding from the Nurses Health Study, where the authors observed an
inverse association between the intake of vegetable fat and the incidence of
gallstones (13). On the other hand, these authors did not observe a significant
association between the disease and polyunsaturated or monounsaturated fatty acid
intakes. Bravo and colleagues showed, that both dietary monounsaturated and
polyunsaturated fatty acids increase the biliary excretion of cholesterol in rats (3).
This was accompanied by an increased cholesterol saturation of the bile in the
animals fed the polyunsaturated fatty acids, but not in those fed the monounsaturated
fatty acids. The authors concluded, that this "may have implications for the risk of
the development of cholesterol gallstone disease" (3).
These findings are in agreement with two studies conducted in hamsters, where
saturated fatty acids were found to intensify gallstone formation while
monounsaturated and polyunsaturated fatty acids caused a reduction (5, 8). Although
in two other studies an association between dietary fat and gallstones could not be
found (16, 24), and one of these even observed a higher intake of monounsaturated
fatty acids in patients with gallstones (16), the general consensus from the studies
conducted so far is that a high intake of saturated fatty acids appears to be a risk
factor for gallstone formation, while the intake of monounsaturated fatty such as
olive oil, and possibly also polyunsaturated fatty acids, might protect against
gallstone formation. On the other hand there are still some open questions, e.g. why
some investigators did not observe a protective effect of monounsaturated fatty acids
while others did, and what the implications of dietary fatty acids in the aetiology of
gallstone formation are. Thus, further investigation is needed to clarify these points.
Summary
From the existing studies on the relationship between dietary fat intake and
physiology and pathophysiology of the gastrointestinal tract, there is evidence, that a
high intake of monounsaturated fatty acids exerts beneficial effects on the
gastrointestinal tract by reducing gastric acid secretion and preventing gallstone
disease. The impact of the dietary fat composition on other gastrointestinal diseases,
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e.g. reflux oesophagitis or constipation, has not been evaluated thoroughly. There are,
however, some studies, which suggest further favourable effects of diets rich in
monounsaturated fatty acids. Barltrop and Oppe observed in infants, that olive oil is
more quantitatively absorbed than butterfat (2). Ballesta and colleagues were able to
show, that in dogs olive oil improves the digestibility and metabolic utilisation of
dietary protein (1). Furthermore, initial studies on the effect of olive oil or oleic acid
with regard to gastrointestinal motility and gastric emptying, show that oleic acidrich meals delay gastric emptying compared with saturated fatty acid-rich meals,
therefore supporting the reservoir function of the stomach (27). Spiller et al. (26)
described an accelerated colonic transit when oleic acid was added to test meals.
However, they did not compare oleic acid with other fatty acids, so it remains to be
proven if this effect is true for fat in general or if it is a specific feature of
monounsaturated fatty acids.
In conclusion, although many questions are still open, there is a body of evidence
that the consumption of olive oil has beneficial effects on different metabolic
functions of the gastrointestinal tract.