Expanded question: Can extra virgin olive oil cause high cholesterol?

No, extra virgin olive oil (EVOO) does not cause high cholesterol. In fact, the consumption of EVOO has been associated with beneficial effects on lipid profiles.
Several studies have demonstrated that EVOO can lower LDL cholesterol (LDL-c) levels. For instance, a study by Correia et al. found that the intake of polyphenol-rich EVOO significantly decreased serum LDL-c levels in healthy adult volunteers.[1] Additionally, a systematic review and meta-analysis by Morvaridzadeh et al. indicated that EVOO consumption did not significantly affect total cholesterol or LDL-c levels, but it did show beneficial effects on insulin and insulin resistance.[2]
Furthermore, the National Lipid Association recommends the use of monounsaturated fats, such as those found in EVOO, as part of a heart-healthy diet to manage dyslipidemia.[3]
Overall, the evidence suggests that EVOO, particularly when rich in polyphenols, can improve lipid profiles rather than cause high cholesterol.

References

1.
The Metabolic and Analytical Changes of Healthy Volunteers Upon Intake of Portuguese Extra Virgin Olive Oil: A Comparison Study Between Pre- And Post-Intervention.

Correia M, Moreira I, El Maghariki J, et al.

Nutrients. 2023;15(15):3351. doi:10.3390/nu15153351.

(1) Background: Extra virgin olive oil (EVOO) is studied mostly for its health benefits in preventing non-communicable chronic diseases, particularly within a Mediterranean dietary pattern. However, few studies have addressed the effect of EVOO in healthy individuals, prior to an established disease. This study aims to evaluate the impact of Northern Portuguese polyphenol-rich EVOO (NPPR-EVOO) consumption on various important clinical parameters in healthy adult volunteers. (2) Methods: This quasi-experimental intervention study assessed the impact of NPPR-EVOO for a period of 100 days. Serum total cholesterol, HbA1c, HDL-c, LDL-c, and CRP, and anthropometric measures-waist and hip perimeters, hand grip strength, and body fat-were assessed and food logs were analyzed. (3) Results: Serum HbA1c (5.12 ± 0.32%; 4.93 ± 0.24, = 0.000) and LDL-c (96.50 ± 28.57 mg/dL; 87.41 ± 31.38 mg/dL, = 0.017) significantly decreased following NPPR-EVOO. Also, daily energy significantly increased, but no changes in other dietary parameters, or anthropometry, were seen. Adherence to the Mediterranean diet did not explain the differences found in individuals regarding serum lipid profile and HbA1c, reinforcing the role of EVOO's effect. (4) Conclusions: NPPR-EVOO lowered the serum levels of LDL cholesterol and HbA1c, providing clues on the effect of EVOO-putative health benefits. These results pave the way for a deeper exploration of EVOO as a functional food.

2.
Effect of Extra Virgin Olive Oil on Anthropometric Indices, Inflammatory and Cardiometabolic Markers: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Morvaridzadeh M, Cohen AA, Heshmati J, et al.

The Journal of Nutrition. 2024;154(1):95-120. doi:10.1016/j.tjnut.2023.10.028.

Background: A large body of literature associated extra virgin olive oil (EVOO) consumption with low risk of cardiovascular disease and mortality. However, findings from clinical trials related to EVOO consumption on blood pressure, lipid profile, and anthropometric and inflammation parameters are not univocal.

Objectives: The aim of this systematic review and meta-analysis was to evaluate the effect of EVOO consumption on cardiometabolic risk factors and inflammatory mediators.

Methods: We searched PubMed/MEDLINE, Scopus, and Cochrane up through 31 March, 2023, without any particular language limitations, in order to identify randomized controlled trials (RCTs) that examined the effects of EVOO consumption on cardiometabolic risk factors, inflammatory mediators, and anthropometric indices. Outcomes were summarized as standardized mean difference (SMD) with 95% confidence intervals (CIs) estimated from Hedge's g and random-effects modeling. Heterogeneity was assessed by Cochran Q-statistic and quantified (I2).

Results: Thirty-three trials involving 2020 participants were included. EVOO consumption was associated with a significant decrease in insulin (n = 10;

Smd: -0.28; 95%

Ci: -0.51, -0.05; I2 = 48.57%) and homeostasis model assessment of insulin resistance levels (HOMA-IR) (n = 9;

Smd: -0.19; 95%

Ci: -0.35, -0.03; I2 = 00.00%). This meta-analysis indicated no significant effect of consuming EVOO on fasting blood glucose, triglycerides, total cholesterol, low density lipoproteins, very low density lipoproteins, high density lipoproteins, Apolipoprotein (Apo) A-I and B, lipoprotein a, blood pressure, body mass index, waist circumference, waist to hip ratio, C-reactive protein, interleukin-6, interleukin-10, and tumor necrosis factor α levels (P > 0.05).

Conclusions: The present evidence supports a beneficial effect of EVOO consumption on serum insulin levels and HOMA-IR. However, larger well-designed RCTs are still required to evaluate the effect of EVOO on cardiometabolic risk biomarkers. This study was registered in PROSPERO as CRD42023409125.

3.
National Lipid Association Recommendations for Patient-Centered Management of Dyslipidemia: Part 2.

Jacobson TA, Maki KC, Orringer CE, et al.

Journal of Clinical Lipidology. 2015 Nov-Dec;9(6 Suppl):S1-122.e1. doi:10.1016/j.jacl.2015.09.002.

However, some vegetable oils are higher in MUFA, such as canola, high-oleic safflower, and olive oils, while others are higher in PUFA, such as corn and safflower oils. Consequently, consumers and clinicians should understand the effects of different vegetable oils on lipoprotein lipid levels. A controlled feeding study conducted by Maki et al. evaluated the effects of a PUFA-rich corn oil and a MUFA-rich extra-virgin olive oil (4 tablespoons/day were incorporated into foods) as part of a weight maintenance diet (34% of energy from fat, ∼8% from saturated fatty acids) on lipids and lipoproteins in men and women with elevated LDL-C. Consumption of the corn oil diet reduced LDL-C by 10.9% compared to subjects' baseline (average American) diets, which was significantly greater than the reduction of 3.5% with extra-virgin olive oil. Results were similar for non-HDL-C, with a significantly greater mean reduction of 9.3% with corn oil vs 1.6% with extra-virgin olive oil. The HDL-C responses were similar between treatments; however, there was a smaller increase in TG on the corn oil (3.5%) vs the extra-virgin olive oil (13.0%) diet. These results are generally consistent with those from other studies, and support the view that greater reductions in atherogenic cholesterol levels should be expected when saturated fatty acids are replaced with PUFA (omega-6) compared to MUFA (omega-9). However, it should be noted that other factors, such as the higher plant sterol content of the corn oil, may have also contributed to the lipoprotein lipid changes observed in the study by Maki et al.