Extra-Virgin Olive Oil for Atherosclerosis: Dosing and Implementation
Patients with atherosclerosis should consume ≥4 tablespoons (approximately 50 grams) of extra-virgin olive oil daily as their primary culinary fat, integrated within a Mediterranean dietary pattern. 1, 2
Recommended Daily Amount
- Consume 25-40 grams daily depending on individual energy needs, with the PREDIMED trial specifically using ≥4 tablespoons (approximately 50 g/day) of extra-virgin olive oil 1
- Each 10 g/day increase in extra-virgin olive oil consumption reduces cardiovascular disease risk by 10% 2
- Participants in the highest tertile of olive oil consumption demonstrated 35% lower cardiovascular disease risk compared to lowest consumers 1, 2
How to Use Extra-Virgin Olive Oil
Replace all saturated fats systematically:
- Substitute butter, margarine, lard, and animal fats with extra-virgin olive oil in all cooking and food preparation 2, 3
- Use as the primary cooking oil for sautéing, roasting, and baking 3
- Use as salad dressing and for drizzling over vegetables 2
- Avoid tropical oils (coconut and palm oil) which should be replaced with extra-virgin olive oil 3
Critical Context: Dietary Pattern Integration
Extra-virgin olive oil must be consumed within a Mediterranean dietary pattern for maximal benefit, not as an isolated intervention. 1, 2 The 30% reduction in major cardiovascular events observed in the PREDIMED trial reflected synergistic effects when olive oil was combined with: 1
- Tree nuts and groundnuts ≥3 servings/week (30g daily) 1
- Fresh fruits ≥3 servings/day (≥200g daily) 1
- Vegetables ≥2 servings/day 1
- Legumes up to 400g/week as partial replacement for red meat 1
- Whole grains (2 servings/day) replacing high glycemic index refined starches 1
- Oily fish 1-2 times/week 1
Why Extra-Virgin Olive Oil Specifically
Extra-virgin olive oil provides superior cardiovascular protection compared to refined olive oil due to its high polyphenol content. 2, 4 The mechanisms include:
- Reduces LDL-cholesterol and triglycerides without reducing HDL-cholesterol through PPARα and PPARγ pathway activation 2
- Anti-inflammatory effects from high oleic acid and polyphenol content 2
- Decreases blood pressure, improves insulin sensitivity, reduces subclinical inflammation, and controls hemostatic processes 1
- Higher-phenolic extra-virgin olive oil at lower dosages (8g/day with 1021 mg/kg phenols) appears more effective than lower-phenolic varieties at higher dosages 5
Evidence Strength
The recommendation is based on the PREDIMED trial (2013), which demonstrated:
- 31% reduction in major cardiovascular events (MI, stroke, or cardiovascular death) with Mediterranean diet supplemented with extra-virgin olive oil versus low-fat control diet 1, 2
- 42% reduction in stroke risk specifically 1
- Adjusted hazard ratios of 0.72 (95% CI, 0.54-0.95) for the primary composite endpoint 1
This represents moderate-quality evidence from a large randomized controlled trial with 7,447 participants followed for median 4.8 years. 1
Alternative Oils When Extra-Virgin Olive Oil Unavailable
If extra-virgin olive oil is not available, use soybean, canola, sunflower, safflower, or corn oils as excellent alternatives, all of which reduce cardiovascular morbidity and mortality. 1, 3 These oils rich in polyunsaturated fatty acids reduce coronary heart disease by 29% when replacing saturated fats. 1, 3
Foods to Strictly Limit
Simultaneously eliminate these atherosclerosis-promoting foods:
- Processed and red meat - replace with legumes or poultry 1
- High glycemic index refined starches - replace with whole grains 1
- Sugar-sweetened beverages - strictly limit 1
- Partially hydrogenated oils containing trans fats - completely eliminate 3
Common Pitfall to Avoid
Do not add extra-virgin olive oil on top of existing dietary fats. The cardiovascular benefit comes from replacement of saturated and trans fats, not simply adding more total fat to the diet. 1, 3 The PREDIMED trial participants replaced unhealthy fats rather than increasing total fat intake. 1