Research Reveals Whether Olive Oil Meaningfully Lowers ApoB and Cholesterol Risk Over Time
“Not all fats are created equal, and choosing the right ones is key to managing ApoB."
Cardiovascular researchers have spent years zeroing in on apolipoprotein B (ApoB) as a sharper predictor of heart disease risk than standard cholesterol numbers. That has put olive oil a staple of the Mediterranean diet under the microscope, with several recent trials testing whether swapping saturated fats for extra virgin olive oil actually moves the needle on ApoB and broader cardiometabolic markers.
Here is what current studies and clinicians are saying about olive oil, ApoB and the diet patterns that surround it.
How olive oil influences apolipoprotein B
Apolipoprotein B is the structural protein attached to the cholesterol-carrying particles that drive atherosclerosis, and what you eat plays a direct role in how many of those particles your body produces. Saturated fat is a key lever.
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According to SiPho Health, “Saturated fats, found primarily in animal products and tropical oils, stimulate the liver to produce more ApoB-containing particles. When you consume saturated fat, your liver packages it into VLDL (very low-density lipoprotein) particles for transport throughout the body. Each VLDL particle contains one ApoB molecule, so increased VLDL production directly raises ApoB levels. Additionally, saturated fats can reduce the activity of LDL (low-density lipoprotein) receptors on liver cells, impairing the clearance of ApoB particles from circulation.”
Replacing saturated fat with monounsaturated fat sources such as olive oil is one of the most commonly cited strategies for shifting that balance. The Princeton Longevity Center notes that “diets low in saturated fat and refined carbohydrates (including added sugars), and rich in dietary fiber, particularly soluble fiber from foods like oats, beans and berries, along with heart-healthy fats such as omega-3 fatty acids and monounsaturated fats from olive or avocado oil, are most effective for improving ApoB levels.”
What the research says about olive oil and cholesterol
Multiple trials have tested olive oil’s role inside Mediterranean-style eating patterns. A 2011 controlled trial assessed 551 participants across three diets a traditional Mediterranean diet with extra virgin olive oil, a Mediterranean diet with nuts and a low-fat diet. The Mediterranean diet enriched with virgin olive oil produced a reduction in ApoB.
A larger 2018 trial enrolled 7,447 adults in Spain who were at high risk for cardiovascular disease but had not yet had a heart attack or stroke. Participants followed one of three eating plans: a Mediterranean approach supplemented with EVOO, the same pattern supplemented with mixed nuts, or a reduced-fat diet. The Mediterranean patterns with extra virgin olive oil or nuts cut major cardiovascular events by about 30% compared with the reduced-fat diet. The study was not designed to measure ApoB as a primary outcome, but it offered strong evidence that a Mediterranean dietary pattern rich in extra virgin olive oil supports cardiovascular health.
A 2024 study looked specifically at people with insulin resistance who switched from a diet high in saturated fat (from lard) to one in which that fat was replaced with olive oil. Researchers tracked how LDL particles moved through the body. When participants ate the olive oil diet, their LDL cholesterol fell, fewer LDL particles circulated in the blood, and the body cleared LDL particles faster. Because each LDL particle carries one ApoB molecule, fewer particles mean less ApoB overall. The study did not directly report fasting ApoB, but it suggests olive oil may lower ApoB by helping the body remove LDL particles more efficiently when it replaces saturated fat.
When more olive oil is not necessarily better
A 2024 randomized crossover trial paired weekly cooking classes with a whole-food, plant-based diet that varied in extra virgin olive oil (EVOO) intake. Adults at risk of cardiovascular disease followed a high-EVOO and a low-EVOO version of the diet for four weeks each, separated by a one-week washout.
According to the study, “In 40 participants, fat intake comprised 48% and 32% of energy during high and low EVOO phases, respectively. Both diets resulted in comparable reductions in LDL‐C, total cholesterol, apolipoprotein B, high‐density lipoprotein cholesterol, glucose and high‐sensitivity C‐reactive protein.”
The authors concluded, “Both plant‐based diet patterns improved cardiometabolic risk profiles compared with baseline diets, with more pronounced decreases in LDL‐C after the low EVOO diet. Addition of EVOO after following a low intake pattern may impede further lipid reductions.”
Monica Aggarwal, MD, FACC, clinical associate professor, adjunct in the Division of Cardiovascular Medicine at the University of Florida and lead author of the study, told Medical News Today, “One of the key differences between a Mediterranean diet and a whole food plant-based diet is the amount of fat and specifically olive oil in the diet. I wanted to understand if the EVOO itself was good in a diet or just less bad than the alternative.”
How to build an ApoB-friendly diet around olive oil
For people trying to translate this research into daily meals, clinicians point to swaps that lower saturated fat while keeping monounsaturated fats in the rotation. Dr. Jeremy Rogers, per Plotline, says, “Not all fats are created equal, and choosing the right ones is key to managing ApoB. Healthy unsaturated fats, including monounsaturated and polyunsaturated fats, can help improve your cholesterol profile without raising ApoB. You can find these beneficial fats in foods like avocados, olive oil, almonds, walnuts and sunflower seeds. Try using olive oil as your primary cooking oil, adding avocado to your toast or snacking on a small handful of nuts. These simple swaps help you replace less healthy saturated fats with options that actively support your heart health and contribute to a better lipid balance.”
Rogers also points to the broader Mediterranean pattern. “The Mediterranean diet is consistently linked to better heart health, and for good reason. This approach centers on whole foods fruits, vegetables, nuts, legumes and whole grains, with olive oil as the primary source of fat. Research shows that individuals with lower ApoB levels often follow a Mediterranean-style diet.”
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