Olive Leaf Extract: Research, Treatment and Applications with Dr. Damian Kristof and Ian Breakspear

Olive Leaf Extract: Research, Treatment and Applications with Dr. Damian Kristof and Ian Breakspear

Naturopath, Academic and Researcher, Ian Breakspear educates us on the properties and clinical benefits of Olive Leaf Extract in our latest podcast. Ian provides our ambassador, Dr. Damian Kristof with an insight into the upcoming research into the benefits of Olive Leaf Extract for Type 2 Diabetes Mellitus and cardiovascular health alongside its anti-inflammatory, antioxidant properties.

Having completed research into phyotchemical composition of varying Olive Leaf Extracts in the Australian and American markets, Ian walks Damian through the varying options available and importantly, Ian describes the properties of a therapeutically superior Olive Leaf Extract and its clinical benefits.

Covered in this episode

[01:05] Welcoming Ian Breakspear
[03:12] History of olive leaf extract
[04:11] Olive leaf extract has potential for immune and cardiometabolic disease
[06:49] Key differences between practitioner-only and over the counter olive leaf extract products
[13:00] Olive leaf extract and diabetes
[15:16] Safety of olive leaf extract in pregnancy
[17:07] Optimal oleuropein to hydroxytyrosol ratio
[21:14] Doses for various conditions and situations
[24:53] Potential side effects and maximum dosage
[27:47] Safely prescribing olive leaf extract for children and pregnancy
[29:13] Using olive leaf extract alongside cancer treatment
[32:06] Additional clinical applications of olive leaf extract
[33:25] Thanking Ian and closing remarks

Key takeaways

Olive Leaf Extract has a long history of medicinal use, with records dating back to 1854.
Olive Leaf Extract may benefit immune and infectious diseases and cardiovascular and metabolic diseases.
Research has found that oleuropein and hydroxytyrosol in Olive Leaf Extract are the active constituents, with greater levels obtained in fresh Olive Leaf Extract as opposed to dry extracts.
Varying levels of oleuropein and hydroxytyrosol were identified in over the counter and practitioner only products.
Oleuropein breaks down to hydroxytyrosol when dried, or in the body.
The extraction process of Olive Leaf Extract with the highest oleuropein and hydroxytyrosol was either water or glycerol based (rather than alcohol extract) with higher amounts found predominantly in over-the-counter products.
Olive Leaf Extract benefits for blood glucose regulation in Type 2 Diabetes Mellitus is underway.

Resources discussed in this episode and further reading

Antioxidant action of Olive Leaf Extract

Research: Antioxidant actions of olive leaf extract (Olea europaea L.) on reactive species scavengers (Goldschmidt Lins, et al., 2020)

Research: Microbiological and Antioxidant Activity of Phenolic Compounds in Olive Leaf Extract (Borjan, 2020)

Anti-inflammatory action of Olive Leaf Extract

Research: Oleuropin is responsible for the major anti-inflammatory effects of Olive Leaf Extract (Qabaha, 2018)

Transcript

Damian: This is FX Medicine bringing you the latest in evidence-based, integrative, functional, and complementary medicine. I'm Dr. Damian Kristof, a Melbourne-based chiropractor and naturopath, and joining us today is Ian Breakspear. Ian is a herbal and naturopathic clinician, educator, and researcher, with 30 years of experience in the profession. In addition to his undergraduate clinical qualifications, Ian holds a master's degree in herbal medicines from the Faculty of Pharmacy at the University of Sydney. As well as clinical practice, holding numerous board positions and teaching as a senior lecturer at Torrens University, Ian finds time to actually do research. And Ian's research focuses on herbal quality, safety, and efficacy, as he is currently engaged in a clinical trial assessing the value and safety of olive leaf extract in type 2 diabetics.

In 2021, Ian was the recipient of the BioCeuticals Integrative Medicine Awards, the BIMA, for contribution to research and education. This BIMA recognises industry thought leaders, researchers, and educators. And this particular award is for those who have helped raise the standard of education in the complementary medicine profession and have added to the body of evidence for natural medicines. Nominees in this category are recognised authorities in the industry. What a CV!

Ian, thank you so much for joining us today.

Ian: Pleasure, Damian. Good to be here.

Damian: Thanks, Ian. Now, Ian, I've met you. We chatted. We've had a little interview when we were up in Sydney together and I loved what you were doing. But I'd love it if you could tell our audience who you are and what do you do.

Ian: Yeah, sure. So I'm a naturopath and herbalist, been a herbalist for about 30 years now and an educator for a number of years as well, and in the last few years getting involved in research as well. One of the projects been focusing on olive leaf extract. And for me it's been interesting because I use olive leaf extract clinically. But now, I'm able to delve into it in different ways from the research perspective and really answer some of the questions I have as a clinician as well about it.

Damian: Yeah, nice. Can you tell us about the history and traditional uses of olive leaf extract, just as we kick this off, just to kind of understand its history? Where does it all come from?

Ian: Yeah, sure. So it's a little bit hard to trace that history. It's like a lot of things with herbal medicine. Tt's quite an oral tradition and not as much documented, particularly, you know, a few 100 years ago. But one of the earliest accounts we do have is in the pharmaceutical journal from 1854 where Daniel Henry, who was an English botanist and pharmacognosist was writing about a colleague's use of olive leaf to treat fever and malaria. And it seems that a lot of that came out of Spanish doctors prescribing it as an anti-fever medicine, particularly in the 19th century. So that then obviously spread to England and spread outwards from there. And of course, these days, we are looking at it for a lot of other uses as well.

Damian: Yeah, it's interesting because my first usage of olive leaf extract was for viral infection. But it appears that with the research and what you've been exploring, it seems that there's many more uses than just for a viral infection.

Ian: Yeah, definitely. I think, broadly speaking, you can kind of categorise the activity of olive leaf into immune and infectious diseases and cardiovascular and metabolic disease care. And, obviously, there's some crossover there, things like its anti-inflammatory action, its antioxidant action. It does allow it to cross those two areas. But yeah, I'd say broadly speaking, it's that immune and infectious disease and cardiovascular and metabolic disease where the focus is.

Damian: Yeah, I find it really interesting because obviously, cardio-metabolic diseases are very much lifestyle-driven, you know? So, they are very much issues surrounding the way in which we consume food, the way in which we live our life. Are we exercising enough? Are we being mindful enough? Are we taking time out? Are we been parasympathetic enough or we're running around a sympathetic-dominant state where we're fighting and flighting all the time? Obviously, when we're taking herbs, or when we're taking other types of ingredients, whether it be vitamins or minerals or pharmaceutical drugs, these are to supplement a healthy diet or a healthy lifestyle. So we're saying, combined with a healthy lifestyle, we can now use olive leaf extract and get an incredible result with cardio-metabolic disease. That's what we're saying. Yeah?

Ian: Yeah, that's essentially it. It's interesting in that a lot of the research, a lot of the clinical trials have obviously not involved a lot of dietary and lifestyle intervention, things like hypertensive patients and so forth because they have been trying to determine specifically the activity of olive leaf versus placebo, for instance.

Damian: Sure. Yeah.

Ian: But certainly, from my clinical experience, yeah, you've got to do the baseline, you've got to do the diet, you've got to do the lifestyle as the baseline, and then our herbal medicines are the medicines. They come in and help us change existing states of disharmony and health issues for the better in patients along with their lifestyle and dietary change.

Damian: Yeah, it's a great message. And it brings us right back to our core philosophies as naturopaths and naturopathic clinicians, that nature cures. It's a great thing to remember. And I hope everyone who's listening to this sees all the information that we're going to present today as an adjunct to a healthy lifestyle, or a healthier lifestyle.

So I want to ask you, Ian, obviously, there's heaps of different products out there, and you rock on down to a health food store or you go into your local supermarket that's got a health food aisle, and you see a whole heap of olive leaf extracts. Is there much of a difference between the different types of products out there?

Ian: Yeah, there certainly is, Damian. And that was the focus of my research that I completed a couple of years ago was really trying to answer that question. And the research project started when I was engaged with a scientific advisory committee for one of the olive companies. And we've finished the first inaugural meeting, and we're sitting around just having an informal chat, and I was talking about olive leaf and how I use it clinically, but how sometimes I get some good results and sometimes not so good results in patients. And wouldn't it be interesting if we could finally chemically profile different olive leaf extracts and just see what's going on in terms of their overall photochemistry?

And yeah, after that little conversation, it obviously intrigued a few people around the table. And we started to put together a project, and the Olive Wellness Institute was fantastic in funding it for me. And yeah, we looked at answering that question. What is the similarity and what is the difference? And yeah, I could probably talk at length about that, but yeah, I think I'll open it up to you around specific questions around that now.

Damian: Yeah, well, how will the listeners, how will they be able to decide on what are the most effective or what is the best quality olive leaf extracts that they can get out there? How can they find that sort of information out? Should they be going to your research study and finding out that? Or are you able to reveal that to us today?

Ian: Well, I can certainly give some good pointers about what clinicians really should be looking for in using olive leaf extract. So, the research I did profiled five over-the-counter and five practitioner-only liquid olive leaf extracts. So, I took it down to Modern Olives's laboratory, ran it through analysis looking at a whole range of different chemicals in the plant, not just one or two, but a whole range of them. And what came out of this very clearly was that the oleuropein and the hydroxytyrosol levels, both of which are considered important in a lot of the activity of olive leaf, were enormously variable between different products, but also particularly - and this was really eye-opening - between over-the-counter category of products and the practitioner-only category of products. There was a massive difference.

So just for example, with the oleuropein level, there was a 13.4 fold variation in oleuropein level from the one with the lowest to the one with the highest. So 13 times variation...

Damian: Wow.

Ian: ...which is huge. And then, looking at the over-the-counter versus practitioner-only category was where it really got fascinating. There was a clear trend to the practitioner-only products having much less oleuropein than the over-the-counter products but higher hydroxytyrosol. And this kind of really intrigued me. So I'm trying to look for an answer for that. And what came out of that was the different forms of extracts that they were using between over-the-counter and practitioner only, four out of the five practitioner-only products were made from dry leaf, whereas four out of five of the over-the-counter were made from fresh leaf. And that makes a lot of sense. When you look at oleuropein, it does break down over time to hydroxytyrosol. So that kind of points to the first observation, which is you really ideally want an extract made from fresh leaf. That's the first pointer I think.

Damian: Okay. That's a good thing. So we want fresh, which is fresh is best. That's what we're saying here. And the oleuropein is greater in the fresh, and we know that oleuropein is the active constituent that we want the most of in our standardised extracts. That's what we're saying, yeah?

Ian: Yeah, we still do want hydroxytyrosol. That is important in the overall activity.

Damian: Okay.

Ian: And of course, the other biophenols are also really important. But what was interesting in my analysis was that, yeah, there was differences between the different in products in their total biophenols, in their hydroxytyrosol, bu there was only this interesting clear trend between oleuropein levels in the over-the-counter versus practitioner and hydroxytyrosol compared to practitioner and OTC. That was really the key trend that came out on this.

Damian: Now, obviously, there's ways in which you can extract it. I mean, you could soak it in water. We might get some stuff out. There's glycetract extracts, and then there's alcohol. Did you find much of a difference in that space?

Ian: Yeah, so what was interesting again there, was that the practitioner extracts, all of them were made using ethanol and water as the extraction medium. With the over-the-counter products, none of them used ethanol. It was all water and glycerol. And quite clearly from the results that we see in this study, the ethanol did not confer any advantage in the extraction of the main chemistry of olive leaf. It was obvious that most of it is water soluble. And certainly the water and glycerol products, the over-the-counter products, compared favourably and beat out the practitioner-only products in their oleuropein levels.

Damian: Wow. Okay, this is good. So we're now saying fresh is best. This is really important. And that the glycerine and water outperformed the ethanol extract.

Ian: Yeah, definitely. And I think we need to remember this is specific to olive leaf. It's not necessarily generalisable across all herbal medicines. It's going to vary from herb to herb. But this is quite clear from the research I've done on olive leaf. Yeah.

Damian: Yeah. Wow. Okay. Now, what are the other things that you're investigating olive leaf extracts and its uses for? So you're doing some specific research around tolerance for diabetics or safety for diabetics. Is that correct?

Ian: Yeah. So Associate Professor Matthew Leach from Southern Cross University and myself are collaborating on a small pilot clinical trial looking at the role of olive leaf in type 2 diabetics in helping to regulate their blood sugar regulation. So, we've actually received funding again from the Olive Wellness Institute for this, and we're in the process of getting a little bit more funding hopefully just to cover some additional unexpected costs to start recruiting patients shortly.

Damian: That's exciting. So where do you see that this might go? Where do you reckon this research is going to go? Or where do you hope it's going to go?

Ian: Yeah, well, in terms of the diabetes, it's a real gap in the research at the moment. We do have some studies that have looked at obese males, middle-aged males, and looking at metabolic syndrome there that show some promising effects on things like lipid and glycemic regulation, but not specifically in type-2 diabetes. So that's kind of I think the next step is what we're doing is this pilot study. And if we see some interesting results from there, potentially, we can scale it up eventually to a larger study to get some more conclusive information about whether it actually may have a clinical role in helping to stabilise blood sugars in diabetics.

Damian: Yeah, no, so we're talking type-2 diabetes yeah? Is that right? Or type-1?

Ian: Yeah, that's correct. Yeah. And the potential is interesting, because as we know with diabetics, their risk of cardiovascular disease is massively elevated. And given what we also know from other studies on blood pressure regulation, blood lipids, etc., that's a really interesting possibility here to use a medicine that can cover a lot of aspects of overall risk of chronic disease in diabetics, potentially.

Damian: Yeah, that sounds profound. Just as you're talking, Ian, I'm thinking, "Oh, yeah, well, if it works for type-2 diabetes, could this be something, if it's safe during pregnancy, could that be beneficial for gestational diabetes? Could this be beneficial for children? Could this be used in early type-1 insulin-dependent diabetes? Could that be possible? And these are the questions that kind of come from the research, which I think as practitioners and clinicians, we'd love to learn this sort of stuff as a safer alternative to medicines and/or having to overuse insulin and insulin resistance, and so on and so forth.

Ian: Yeah, and certainly, I've seen a lot of patients clinically where insulin and the oral hypoglycemics, they're literally saving their life, but they're not necessarily providing optimal glycemic regulation day-to-day. And they're slightly high in their HbA1c long-term, and that increases their overall risk of chronic complications. So I really see a significant role for obviously, diet, lifestyle, and herbal and naturopathic medicine in general to fill that gap between just the life-saving medications that stop a patient going into acute hypo- or hyperglycemic episodes, and nothing else available to regulate and optimise things long-term to reduce adverse risks that can occur. So yeah, I think there's a big role potentially for herbal and naturopathic medicine there.

Damian: Yeah, totally. And as you said, multi-pronged. So not only are we looking at glycemic control, but there's the other chemicals, the polyphenols that are found in olive leaf extract that can contribute to antioxidant activity, anti-inflammatory activity, which is of huge benefit to the cardiometabolic system.

I just want to like kind of go back a little bit, because we did touch on oleuropein and hydroxytyrosol. Now, is there a particular specific ratio that we could ever be aware of as practitioners that we might look for? Sometimes you hear about ratios of particular active components. Or is it just that you want lots of oleuropein and some hydroxytyrosol is fine? Is there something that we should be looking for?
Ian: Yeah, that's a really interesting question. And, to my knowledge, it's not something that's been fully answered from the research yet. What we do know from a number of the clinical trials is that a number of the preparations that have shown good effect in things like blood pressure regulation and blood lipids and reducing the risk of infectious disease and the level of illness and infectious diseases like colds and flus, those preparations have usually been standardised for oleuropein. So that has been obviously clearly important in the overall effect. We do know from other research that hydroxytyrosol is really important in particularly the cardiovascular, some of the anti-inflammatory effect as well, definitely antioxidant, etc.

So we definitely want some hydroxytyrosol in the final preparation, but we also need to remember that, of course, oleuropein, it degrades over time to hydroxytyrosol. But of course, it's also going to degrade in the body to hydroxytyrosol. So over time, by ingesting a higher amount of oleuropein, you're going to get the benefits of oleuropein initially, and then as it is metabolised, you're going to get the benefits of the hydroxytyrosol that's formed as well. So quite clearly, I think optimising within reason the oleuropein level without sacrificing the hydroxytyrosol and the total biophenols is what we're really looking at.

Damian: Okay, and this might be a silly question, but there could be some other people out there that are thinking the same. What is oleuropein? It's a chemical of course, but what do you call it? Is it a...

Ian: Yeah, so it's technically…

Damian: Is it biophenol?

Ian: Well, it fits into the biophenol category, it’s technically a secoiridoid glycoside. It's part of what contributes that really strong bitterness to olive leaf and to a lesser degree olive oil as well.

Damian: Ah, okay, cool, because that's where I was going. So we find oleuropein and hydroxytyrosol, we find that in the leaf. Do we find that in the fruit of olive trees?

Ian: Yes, we do, but it's definitely less. So obviously, olive oil being made for the fruits, you're going to get a lot more of the oil soluble components than you are from the leaf, where you're going to get a lot more of the water-soluble components. So I think there's a complementary role there. You've got higher levels of things like your sterols, maslinic acid in the oil, and, of course your good monounsaturates and stuff like that in the oil that you don't have anywhere near as much of in the leaf extracts.

Damian: Yeah, okay, so we're going to eat the whole plant.

Ian: Yeah. That's the beauty of it.

Damian: Like why wouldn't you? Why wouldn't you eat the whole plant, right? Sit down, put some olives in your salad, cook your fish with your olive oil, and then sip a little bit of olive leaf extract after that just to help you manage the glycemic load of that.

Ian: Yep.

Damian: How unbelievable. What great plan. I wonder who's going to fight over who invented this? Was it the Greeks or the Romans? Who invented it, we'll find out I'm sure. Actually, you might know. Where's the first olive tree from?

Ian: Oh, I honestly don't know the answer to that. But I was reading an interesting study the other day that was basically suggesting that cultivation of the olive tree has been going on for thousands of years, that it's not a new thing, that we've been intentionally cultivating the olive tree for longer than what we had previously expected, much longer. So yeah, pretty interesting. Such a central medicine, a central food in that Mediterranean area for so long.

Damian: Yeah. Now, when we come back to dosage, I think this is important because obviously, we're encouraging our practitioners who are listening to this to be aware of the power of olive leaf extract and how it could be used in practice. And of course, we're using it for viral stuff, but now we might be considering it for glycemic control and cardiometabolic issues. So is there a dose-dependent association for efficacy?

Ian: Yeah, so the studies that have been done, the clinical trials so far, have obviously used lots of different dosages. But the theme that we're really seeing is that, for instance, de Bock in 2013, looking at insurance sensitivity and pancreatic beta cell function, the preparation they used in that that had some good results was 51 milligrams of oleuropein daily. Then there was another study in 2019 looking at sick days and duration of upper respiratory infections in high school athletes that used 100 milligrams of oleuropein daily. And for the cardiovascular effects, there's been a number of studies ranging between 100 to 136 milligrams of oleuropein daily.

So it seems particularly for the cardiovascular effects, we're looking at higher levels of oleuropein than some of the other effects that we would apply olive leaf for as well. And I think particularly, what was really astounding from my research is that when I looked at the maximum recommended dose of all of the practitioner products that I studied, none of them got anywhere near the 100 milligrams. In fact, none of them even reached the 51 milligrams of oleuropein per day at their maximum recommended dose.

Damian: Oh, wow. So in looking at the practitioner-only products that are out there for the most part, at the moment, none of them at their maximum suggested dose got to 51 milligrams of oleuropein.

Ian: Yeah, one of them got close, which was, interestingly, the one practitioner product that was made from fresh leaf, the only one, but the rest were way under 51 milligrams. And what was intriguing for me as well, is the particular product that I was using at the time when my patients turned out to have the lowest levels of oleuropein of all of them, so very informative to me clinically as well. This is ideally what we want with the research that really informs our clinical practice long term.

Damian: Yeah. Okay. So it appears to me that we want to be looking for a product that's going to have in its dosage, or at least its maximum dose over the course of a day, at least 100 milligrams. That's what we're going to really want, isn't it?

Ian: Yeah, generally speaking. And another fascinating thing that I found as well is that all of the over-the-counter products declared on the label how much oleuropein or hydroxytyrosol, or both, was in there per meal or per dose. None of the practitioner products declared it. So none of the practitioner liquids gave any indication of what the oleuropein level was, which, to me, was a little disappointing because, as a clinician, I'm trained to be able to make some decisions around the dosing that I need for the patients, prescribe according to the evidence that's out there. But the information on the label of the practitioner products didn't allow me to achieve that because there was no declaration of oleuropein or hydroxytyrosol or anything.

Damian: Far out. So let's say, for example, you work out that your supplement has less oleuropein than what you want, is there a problem with taking too much? I mean, if you take too much glycerol, is that a diarrhoea issue? Is that what we're talking about here? Or what could happen if you take too much of it?

Ian: Yeah, well, that's a really good question. And again, we don't have a lot of solid data on that, but we do know that obviously if you're looking at an alcohol-based extract, if you're looking at these practitioner products that are made with alcohol, you're going to have to double or triple the dosage, the maximum dosage recommended, which of course means double or triple the ethanol that the patient's consuming as well, and that could get a little problematic sometimes, as we know.

With glycerol, I've certainly had some patients that react with a bit of mild nausea when they have really large amounts of glycerol. But then, we also do need to realise that really high doses of oleuropein that are too high for the patient can itself cause nausea as well. It is a strong gastric stimulant. So that effect in sensitive patients or when you're using too high a dosage for the individual can also result in nausea. So that needs to be considered. And again, I think part of why we need to know how much oleuropein is in these practitioner products to make that decision.

Damian: Yeah. Do we know what a maximum amount would be per day that someone could have? Like, is it 300 milligrams? Is it 500 milligrams of oleuropein? Or is that going to be a bit dependent on the individual?

Ian: Yeah, so as far as I know, there hasn't been specific upper limits found in the research of oleuropein dosing. If you look at the European Medicines Agency monograph on olive leaf, in their section on overdose, they basically just say, "No case of overdose has been reported." So yeah, we really just don't know for sure on that one.

But certainly, from my clinical experience, yes, certainly, high doses in some people who have sensitive stomachs can be a little bit dicey. And so you, then you just dial it back, see how the patient's going. If they're getting the responses in blood pressure or whatever you're prescribing for, even if it's the lower dose, fantastic, because we know some patients respond really well to low doses of things. Sometimes, you just got to do it based on the individual I think.

Damian: Yeah. Nice. Okay, it just brings it back to what it is that we do. But the good thing to remember, if you've got to increase your dose of the ethanol extract, be careful. Don't go driving if you've been taking olive leaf extract. You'd hate to get pulled over and you blow 0.05 or something, and the police officer says, "You've been drinking," and you say, "No, no, I've just been drinking olive leaf extract." That might not be good.

Ian: Could be, yeah.

Damian: That was joke. And for those people who didn't laugh, that was my attempt at a joke, a bad joke.

Now, is it always safe to use this stuff? Do we need to be careful about kids? Do we have safety data for children?

Ian: Yeah, we don't. We don't have safety data for children. We don't have safety data for pregnant women, or breastfeeding women, either. So, again, the European Medicines Agency, their monograph basically states that for fertility, pregnancy, and lactation, safety during pregnancy and lactation has not been established. In the absence of sufficient data, the use in pregnancy and lactation is not recommended. So they’re erring on the side of caution. There is no reason to suspect phytochemically that it would be a problem. But understandably, they're erring on the side of caution.

Damian: Yeah, yeah. Well, I think that's worth just noting. I mean, obviously, again, it's within our powers or within our skill set to use clinical judgement in these sorts of situations. And obviously, be careful and be mindful of what it is. And of course, we could be chasing the optimal dose. But it doesn't hurt for people to take a smaller amount because they will still get some benefit from it. It may just not be what's clinically effective for say diabetes or sick days with athletes or cardiometabolic function. It still might be virally beneficial for some people. So, but of course, caution with kids and pregnancy breastfeeding is important.

Has there been anything done with cancer? There's so much cancer at the moment, and people are hanging on to dear life hoping that there's going to be an answer. If they are looking to take olive leaf extract with their cancer treatments, would this be okay?

Ian: Yeah. And again, that's an interesting question that needs investigation, because we just don't really have a lot of data on that. There is one study from 2013 where they were using olive leaf extracts for oral mucositis in patients undergoing chemotherapy for cancer. So they were preparing the olive leaf extract as a mouth rinse with the benzydamine and normal saline. And it had really good results in terms of reducing the oral mucositis assessment scale and etc. And the inflammatory mediators as well were significantly decreased, like TNF-alpha levels were decreased in saliva. So that's a really good sign there. But obviously, we do need to consider the potential, particularly for oral usage. Oral ingestion, what drug interactions are we going to have particularly in something as critical as cancer therapy. So we just don't have the answer for that. It really needs exploration at this stage.

Damian: Yeah, yeah. So there's a lot of research that can be done across the board for all medicines, and this is why we do training as practitioners to be safe for our patients. And so, use your clinical judgement, be mindful with how you're prescribing it. But it comes from a herb and we're not just focusing on one extract of a nutrient or a chemical, we're not just doing oleuropein, we're doing an extract of everything that's in the leaf. So for me, it sounds like it's going to be a bit safer. It’s not just a drug.

Ian: Yeah. Potentially, yeah, there's no particular reason when we look at the phytochemistry to suspect a real issue with it. But we just need to really do more research, that's for sure. And I think what you said earlier about using professional judgement, the practitioner using their judgement, this is what clinical practice is about. We need to use our best judgement with the knowledge that we've got there available at the time and realise that sometimes the knowledge evolves.

When I first started practice, nobody knew about St. John's Wort's interaction with various conventional medications. So I reflect on how I prescribed St. John's Wort in my first few years of practice thinking there's probably times I prescribed it in patients in combination with pharmaceutical medications. And that led to increased breakdown, but we just didn't know at the time. And of course, we need to stay up to date. That's how we improve and that's where we improve patient safety.

Damian: Yeah, yeah, that's a great call. I think we've all done that. Do you find that using olive leaf extract with other herbs or nutrients might potentiate its use? That it pairs really well with some things over other things. I mean, what else do you use olive leaf extract with? And for what things are you using it with other than diabetes?

Ian: Yep. So I suppose my main clinical usage personally, using patients with hypertension, and just generally increased cardiovascular risk factors across the board. So, in those patients, I'm very commonly prescribing with crataegus monogyna, or hawthorn, that seems particularly in blood pressure to work well with olive leaf in my experience.

Damian: Sure.

Ian: And yeah, then the rest of it comes down to very much individualised medicine. Some patients with hypertension, it's very stress related. So we're going to be using adaptogens and nervines and so forth, as well as obviously counselling and meditation and stuff like that. For other people, it may be peripheral vascular resistance is really high, so we need more of our peripheral vasodilative medicine. So I think then pairing it according to the individual need and our assessment of that need is really important.

Damian: Yeah. Really good. Some great advice there for everybody who's been listening to this today. Ian, before we finish up, is there anything that we haven't covered today that you'd like to touch on so that our listeners can race out and order more olive leaf extract?

Ian: Yes. So I think the key things that really stood out for me, both in terms of my clinical experience and this research, was that a lot of the practitioner products were not optimal in terms of their oleuropein levels, etc. They didn't have that label declaration that allows us to make an appropriate assessment for what is the right dose for that patient, and that we ideally want to change that long term, that we don't, in the case of olive leaf need ethanol as an extraction medium. It's not conferring any advantage in the extraction. And that we need to ask for that traceability, accountability, and that quantitative declaration from the companies that are supplying us with our medicines.

Damian: Such a great summary. I couldn't have done it better myself, Ian. Great summary. Well done. Really great. And I just want to thank you for joining me, Ian. I know we worked really hard to try to get you on this podcast. And I know all the listeners of FX Medicine will thoroughly enjoy your knowledge and be so impressed with what you do know about this particular ingredient. So thank you so much for joining us.

Ian: Oh, it's a pleasure. And we should get together and talk about olive oil one day again as well.

Damian: Yes, totally. That's definitely not a no for me. I love olive oil. Hey, thanks, everyone for listening today. Don't forget that you can find all the show notes, transcripts, and other resources on the FX Medicine website. I'm Dr. Damian Kristof. Thanks for joining us. And remember to subscribe to us on your favourite podcast app and follow us on social media to make sure that you never miss an episode. And to get more information on Ian, go to ianbreakspear.com.au. And you can find him on Facebook, Instagram and Twitter using the handle IanBreakspear or Ian_breakspear. Thanks again, everybody.

About Ian Breakspear

Ian is a naturopath, herbalist, educator and researcher, with 30 years of experience. Currently a Senior Learning Facilitator at Torrens University, Ian is also in private clinical practice in Sydney, focusing on helping patients with cardiovascular disease and chronic inflammatory conditions.

Ian is a committed leader within the naturopathic profession, having served 8 years on the Board of the Naturopaths & Herbalists Association of Australia (NHAA), where amongst other projects he redeveloped the educational standards for herbalists and naturopaths. In 2006 he was honoured with a Fellowship of the NHAA for “meritorious work in the profession of herbalism”, and in 2021 received the Bioceuticals Integrative Medicine Award for Contribution to Research and Education.

In addition to various journal publications, Ian recently co-authored a chapter on heart disease for a major Australian naturopathic textbook, is a member of the Cobram Estate Olives Expert Scientific Advisory Committee, Chair of the NHAA’s Board Member Advisory Committee, and Chair of the Naturopathic Editorial Committee for the Natural Health Science Foundation.

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