Olive oil

Olive Oil (Olea europaea L.)

1. Identity

Botanical and Chemical Names

Olive oil is a liquid fat obtained by pressing whole olives, the fruit of Olea europaea, a traditional tree crop of the Mediterranean Basin. The oil's CAS registry number is 8001-25-0. It consists mainly of oleic acid (up to 83%), with smaller amounts of other fatty acids including linoleic acid (up to 21%) and palmitic acid (up to 20%).

Quality Grades and Commercial Forms

Olive oil quality classifications are mainly based on free acidity, expressed as equivalents of free oleic acid; the main quality categories include Extra Virgin Olive Oil (EVOO), Virgin Olive Oil (VOO), ordinary virgin olive oil, virgin olive oil not fit for consumption, refined olive oil, olive oil, and olive oil pomace.

Extra virgin olive oil has to be obtained using exclusively mechanical procedures; its free acidity cannot be greater than 0.8%, it must not show sensory defects, and it has to possess a fruity taste. Compared to other culinary oils, olive oil is the richest source of bioactive compounds, but not all olive oil is created equal. Levels of bioactive compounds differ depending on the type of olive oil — extra virgin olive oil and virgin olive oil contain the highest levels of polyphenols — olive varieties used, growing conditions, time of olive harvest, and storage conditions.

It is commonly used in cooking for frying foods or as a salad dressing. It can also be found in some cosmetics, pharmaceuticals, soaps, and fuels for traditional oil lamps.

2. Traditional and Historical Use

Earliest Origins

The first traces of olive cultivation date back over 6,000 years to the Eastern Mediterranean. Wild olives, which originated in Asia Minor, were collected by Neolithic people as early as the 8th millennium BC.

Ancient Egypt

In ancient Egypt, olive oil served both therapeutic and ceremonial purposes. The Ebers Papyrus includes recipes where olive oil, often combined with cedar resin, was used to treat skin ailments, insect bites, joint pain, and even eye infections. In Egypt, olive oil was used for lighting, skin care, and funeral rituals. It is mentioned in pharaonic tombs, where it was offered to the gods or used in the mummification process.

Ancient Mesopotamia and the Levant

The earliest civilizations — the Ancient Egyptians, Assyrians, and Phoenicians — all produced olive oil for both medicinal and culinary purposes. The Ancient Egyptians used olive oil as their main source of fuel for lamps and for use in cooking, as well as for use in religious ceremonies. The Assyrians extracted oil from olives for medicinal purposes, while the Phoenicians produced olive oil for both culinary and medicinal purposes.

Olive oil was used for healing and purification and associated with important rituals from at least the second millennium BCE. Mid-2nd millennium BCE texts from the capital of the Hittite empire (in what is now Turkey) describe the anointing of a newborn child and the mother to ward off the dangers of birth. In ancient Syria the high priestess of the god Baal was initiated with an anointing of "fine oil of the temple."

Ancient Greece and Rome

Ancient Greeks, Romans, and early Christians used olive oil not only as a staple of daily life but as a sacred and medicinal substance, shaping rituals, healing practices, and spiritual traditions that still influence the modern world. For the Greeks, olive oil symbolized wisdom, prosperity, and peace. The olive was a sacred tree dedicated to the goddess Athena.

Hippocrates' texts include over 60 different medicinal uses for olive oil, from treating skin conditions to soothing stomach issues and healing wounds. Olive oil was prescribed as a base for ointments and balms and was also used in enemas and massages to restore balance in the body's humors. Greek athletes would douse themselves in olive oil before competing, believing it enhanced strength and protected the skin. It was then scraped off with a curved metal tool called a strigil, removing dirt and toxins.

Dioscorides recommended olive oil as a cure for nettle stings and a base for many medicinal herbs. Celsus, a Greek medical writer of the second century CE Roman Empire, advised the use of warm water to which a little oil had been added, along with gentle rubbing of the body with oil, for the exhausted patient bordering on fever.

Religious and Ritual Use

Olive oil is mentioned many times throughout the Bible. It was used to light the Menorah in the Temple and was regularly used in cooking by all the major world religions, including Christianity, Judaism, and Islam. Olive oil also gained significance in Islamic culture, praised in the Quran as a symbol of light and health. Olive oil is still used in Christian sacraments, the consecration of churches, and anointing of the sick.

Medieval Period and Renaissance

During the Middle Ages, olive oil production declined in Europe due to war and instability. However, it remained vital in Mediterranean regions, used in monasteries for cooking, medicine, and religious ceremonies. The Renaissance saw a resurgence in the appreciation for olive oil, particularly in Italy and Spain.

3. Key Constituents and Active Compounds

Macrocomponent: Fatty Acids

Olive oil is composed mainly of triacylglycerols (triglycerides or fats) and contains small quantities of free fatty acids (FFA), glycerol, phosphatides, pigments, flavor compounds, sterols, and microscopic bits of olive. The predominant fatty acid present in virgin olive oil is monounsaturated oleic acid (68–82% of the total fatty acids in olive oil). Other fatty acids in olive oil are linoleic acid (2.50 to 21.00%), palmitic acid (7.50 to 20.00%), and α-linolenic acid (≤1.00%).

The beneficial health effects of olive oil are due to high content of monounsaturated fatty acids and antioxidant substances. Olive oil contains both lipophilic (tocopherol) and water-soluble (polyphenols) antioxidants. Oleic acid, linoleic, and linolenic acids are bioactive lipids with anti-inflammatory and/or proresolving activities.

Minor Bioactive Compounds

There are more than 200 minor components in olive oil with biological activities. The most abundant antioxidants in olive oil are tocopherols, β-carotene, lutein, squalene, lipophilic and hydrophilic phenols.

Among the microconstituents are phytosterols, squalene, tocopherols, phenolic compounds, and terpenic acid derivatives. Among them, phenolic compounds — known for their remarkable antioxidant activity — have attracted significant research attention. They are characterized by a complex mixture of compounds occurring in the form of simple phenols, lignan derivatives, secoiridoids, and flavonoids. Secoiridoids and alcoholic phenols, mainly hydroxytyrosol, are present in high amounts in virgin and extra-virgin olive oil.

Phenolic acids and derivatives (vanillic acid, gallic acid), phenolic alcohols (tyrosol, hydroxytyrosol), secoiridoids (oleuropein, oleocanthal), lignans (pinoresinol), and flavones (luteolin) are phenolic compounds of olive oil.

Phytosterols and Squalene

Olive oil contains several phytosterols, including β-sitosterol and campesterol. Phytosterols are similar in composition to cholesterol and help block it from being absorbed. Squalene is a triterpene acid found in olive oil.

Tocopherols (Vitamin E)

The olive oil in its composition contains a significant amount of vitamin E, between 15 and 20 mg per 100 g of olive oil. Vitamin E is an antioxidant compound that protects cells from the action of free radicals. Within olive oil, vitamin E is primarily found in the form of tocopherols.

4. Established Mechanisms of Action

Anti-inflammatory Mechanisms

Olive oil polyphenols have antioxidant, anti-inflammatory, antimicrobial, antiviral, anti-atherogenic, anti-thrombotic, anti-mutagenic, and hypoglycemic characteristics.

Oleocanthal is contained in virgin olive oil and possesses similar anti-inflammatory properties to ibuprofen. In animal models of collagen-induced arthritis, levels of circulatory matrix metalloproteinase (MMP)-3 and proinflammatory cytokines (IL-6, IL-1β, TNF-α, IL-17, IFN-γ) were significantly decreased. Additionally, oleocanthal was able to diminish COX-2, mPGES-1, and iNOS protein expressions, as well as PGE2 levels. The mechanisms underlying these protective effects are related to Nrf-2/HO-1 axis activation and the inhibition of relevant signaling pathways, including JAK-STAT, MAPKs, and NF-κB.

Antioxidant Mechanisms

The phenolic content of olive oil has a role in cardiovascular protection. Clinical trial studies have demonstrated that phenolic compounds of olive oil have antioxidant activity which can protect macronutrients from oxidative damage. A well-designed study and two smaller-scale studies showed a dose-dependent and significant effect of olive oil hydroxytyrosol and related compounds on lowering levels of oxidized LDL (oxLDL) in blood when consumed for three weeks.

Endothelial and Vascular Mechanisms

Studies in animals and humans have shown that a diet rich in EVOO reduces blood pressure, and the hypotensive effect of EVOO has been attributed to its phenol component, for which multiple pharmacological effects have also been shown, such as anti-inflammatory, antioxidant, and radical-scavenging activities; antithrombotic effects; and improved endothelial function. A reduction in saturated fat intake, along with the use of extra-virgin olive oil, markedly lowers daily antihypertensive dosage requirement, possibly through enhanced nitric oxide levels stimulated by polyphenols.

Hepatoprotective Mechanisms

Tyrosol and oleocanthal from EVOO demonstrate hepatoprotective properties. Both compounds have demonstrated antioxidant, anti-inflammatory, and lipid metabolism-modulating effects, which could mitigate chronic liver diseases, such as metabolic-associated liver dysfunction, liver fibrosis, and hepatocellular conditions.

Neuroprotective Mechanisms

Neurological studies have focused on the effects of oleocanthal against Alzheimer's disease. Oleocanthal improved clearance of the amyloid beta protein from neurons and reduced the inflammation of astrocytes. These findings derive largely from preclinical and in vitro models; validation of the biological effects of oleocanthal in animal disease models is limited and should be emphasized in the future.

5. Scientific Evidence by Area of Use

5.1 Cardiovascular Disease

Evidence strength: Strong (for lipid oxidation protection; moderate-to-strong for CVD events in cohort data).

The Mediterranean diet, in which olive oil is the primary source of fat, is associated with a low mortality for cardiovascular disease. Data concerning olive oil consumption and primary endpoints for cardiovascular disease are, however, less abundant than data on secondary endpoints.

The PREDIMED study included 7,216 men and women at high cardiovascular risk, aged 55 to 80 years. Participants were randomized to one of three interventions: Mediterranean diets supplemented with nuts or extra-virgin olive oil, or a control low-fat diet, as an observational prospective cohort analysis. The median follow-up was 4.8 years. During follow-up, 277 cardiovascular events and 323 deaths occurred.

Olive oil has been proven to improve a range of cardiometabolic parameters such as lipid profile, blood pressure, insulin sensitivity, and glycemic control in recent dietary feeding trials.

Clinical trials showed a correlation between an improvement in cardiovascular risk factor parameters and dietary supplementation with EVOO, highlighting the strong antioxidant properties of its polyphenol content. Specifically, improvements in flow-mediated vasodilation and increased nitric oxide availability were observed, contributing to a reduced risk of cardiovascular events. Additionally, decreased levels of C-reactive protein and interleukin-6 were evident, indicating a notable anti-inflammatory effect.

A 2022 systematic review and meta-analysis in Clinical Nutrition found evidence for a protective association of olive oil against CVD, T2D, and all-cause mortality, but not for cancer. Despite some degree of heterogeneity and the inherent limitations of observational studies, regular consumption of olive oil — as the main added fat in the context of a healthy diet — was inversely associated with all-cause mortality, type 2 diabetes, and cardiovascular disease.

Concerning the lipid-oxidation health claim specifically: In 2011, the European Food Safety Authority (EFSA) accorded a health claim to olive oil polyphenols in that they protected LDL particles from oxidative damage. In 2012, an attempt was made to substantiate a health claim related to polyphenols in olive oil and the maintenance of normal blood HDL-C levels, but this was rejected by the EFSA Panel owing to insufficient evidence of an established biological relationship.

5.2 Blood Pressure

Evidence strength: Moderate (small RCTs, mechanistically plausible).

A double-blind, randomized crossover study evaluated the antihypertensive effects of monounsaturated fatty acids (MUFA) from extra-virgin olive oil versus polyunsaturated fatty acids (PUFA) from sunflower oil. Twenty-three hypertensive patients were assigned randomly to MUFA or PUFA diet for 6 months and then crossed over. Resting blood pressure was significantly lower at the end of the MUFA diet compared with the PUFA diet, and daily drug dosage was significantly reduced during the MUFA but not the PUFA diet (−48% vs −4%). All patients receiving the PUFA diet required antihypertensive treatment, whereas 8 of those receiving the MUFA diet needed no drug therapy.

Other studies have also shown that olive oil polyphenols are related to the reduction of CRP, reduced atherogenic gene expression in blood cells, and decreased blood pressure.

5.3 Type 2 Diabetes

Evidence strength: Moderate-to-good (meta-analyses of cohort and RCT data).

A systematic review and meta-analysis published in PMC examined cohort studies and intervention trials on olive oil in the prevention and management of type 2 diabetes. The highest olive oil intake category showed a 16% reduced risk of T2D (RR: 0.84; 95% CI: 0.77, 0.92) compared with the lowest. In T2D patients, olive oil supplementation resulted in a significantly more pronounced reduction in HbA1c (MD: −0.27%; 95% CI: −0.37, −0.17) and fasting plasma glucose (MD: −0.44 mmol/L; 95% CI: −0.66, −0.22) compared with the control groups. This meta-analysis provides evidence that the intake of olive oil could be beneficial for the prevention and management of T2D; this conclusion regards olive oil as a food, and might not be valid for single components.

5.4 Oxidative Stress and LDL Oxidation

Evidence strength: Good (regulatory-level endorsement from EFSA).

A systematic review and dose-response meta-analysis aimed to summarize results of clinical trials assessing the effects of high- versus low-phenol olive oil on oxidative stress biomarkers. Searches covered Scopus, PubMed, Web of Science, Google Scholar, ProQuest, and Embase through July 2021. Eight clinical trials evaluating the effect of phenolic content of olive oil on oxidized-LDL (ox-LDL), malondialdehyde (MDA), or ferric-reducing ability of plasma (FRAP) were included.

According to EFSA, the intake of olive oil — particularly virgin olive oil — has demonstrated cardiovascular benefits due to its fatty acid composition and to the antioxidant action of its naturally occurring polyphenols, mainly hydroxytyrosol and its derivatives.

5.5 Anti-inflammatory Effects

Evidence strength: Moderate (meta-analyses of RCTs; much mechanistic data is preclinical).

The olive oil-supplemented Mediterranean diet is associated with anti-inflammatory effects. A systematic review and meta-analysis evaluated the impact of an olive oil-supplemented Mediterranean diet on pro-inflammatory biomarkers and soluble adhesion molecules, searching PubMed, Scopus, Web of Science, Embase, and CINAHL through June 2024; 15 clinical trials comprising 2,477 adults aged 23–80 years were included.

A meta-analysis of 30 human intervention studies with olive oil showed overall amelioration of antioxidant and inflammatory status of subjects, with beneficial effects being more pronounced in subjects with established metabolic syndrome or other chronic conditions or diseases.

Regarding oleocanthal specifically: In comparison of oleocanthal with other phenolic compounds (including oleuropein aglycone, ligstroside aglycone, oleacein, and oleocanthalic acid), oleocanthal displayed the highest relative antiproliferative and cytotoxic activity across various cancer cell lines. However, oleocanthal may act together with other bioactive compounds in olive oil to achieve its therapeutic potential, and its use as a single therapeutic measure awaits validation from future studies.

5.6 Cognitive Function and Neurodegenerative Disease

Evidence strength: Preliminary-to-moderate for cognition; largely preclinical for Alzheimer's disease (AD).

A systematic review searched the Web of Science, Scopus, PubMed, and Google Scholar through August 2023, reviewing RCTs, cross-sectional studies, cohort studies, and case-control studies on the impact of olive oil consumption on cognitive performance in those older than 55 years. Eleven studies were identified — four cross-sectional studies, four prospective cohort studies, and three RCTs. The cohort studies and RCTs consistently found that olive oil consumption had a favorable effect on cognitive performance across a number of cognitive domains over time. All of the cross-sectional studies reported a positive association with cognitive health. However, further large-scale investigations are required to strengthen this conclusion.

The PREDIMED-NAVARRA RCT found that individuals who had EVOO added to their diet, along with the Mediterranean diet, had better cognitive functioning than those who consumed a control diet, although there were no associations for several cognitive domains. In contrast, a cohort study found that high olive oil intake had no protective effect against Alzheimer's disease or memory decline, claiming that oleic acid, linoleic acid, and palmitic acid have no role in cognitive functioning, unlike the omega-3 fatty acids found in fish oil. Evidence is therefore mixed.

For AD specifically, a systematic review investigated the effect of oleocanthal from EVOO on amyloid-β burden in preclinical models of AD. The literature was searched through six electronic databases until February 2023; screening of 52 articles for inclusion criteria resulted in 7 preclinical reports evaluating the effect of an oleocanthal-supplemented diet on AD trajectories. Evidence remains preclinical.

Modern studies have provided evidence of both the neuroprotective and anti-ageing effects of olive biophenols — oleuropein, hydroxytyrosol, oleocanthal — which have contributed to the preservation of cognitive function in ageing individuals.

5.7 Cancer

Evidence strength: Preliminary; mostly in vitro and animal data. No direct clinical evidence of benefit.

A systematic review and meta-analysis found evidence for a protective association of olive oil against CVD and T2D, but not for cancer. The anti-inflammatory, antioxidative, antimicrobial, anticancer, and neuroprotective activities of oleocanthal have been examined by previous studies. Of these, studies on the anticancer effects have been the most extensive. Oleocanthal was reported to suppress melanoma, breast, liver, and colon cancer cells. These findings are based on cell-line and animal research, and have not been confirmed in human trials. Emerging evidence suggests phytosterols in olive oil may have anti-tumor properties — they have been shown to reduce cancer cell proliferation and breast cancer tumor growth in animals.

5.8 Topical Use: Pressure Ulcer Prevention

Evidence strength: Moderate (four low-risk-of-bias RCTs; GRADE certainty: moderate to low).

Four RCTs met eligibility criteria for a systematic review on topical olive oil for pressure ulcer prevention; all studies were judged at a low risk of bias overall. The meta-analysis showed that clinical efficacy of olive oil for prevention occurs by reducing the incidence of pressure ulcers (RR = 0.56, 95% CI = 0.30 to 0.79, I² = 0%), with no differences in adverse effects, and it may be associated with a shorter development time of pressure ulcers and shorter hospital stays. The certainty of evidence assessed by the GRADE approach was moderate and low. The topical application of olive oil is effective and safe in reducing the incidence of pressure ulcers compared to other treatments.

6. Body Systems and Health Areas of Association

• Cardiovascular system: Improvements in flow-mediated vasodilation and increased nitric oxide availability were observed, contributing to a reduced risk of cardiovascular events.
• Metabolic and glycemic regulation: Olive oil has been proven to improve a range of cardiometabolic parameters including lipid profile, blood pressure, insulin sensitivity, and glycemic control.
• Central nervous system: Modern studies have provided evidence of neuroprotective and anti-ageing effects of olive biophenols, contributing to the preservation of cognitive function in ageing individuals.
• Gastrointestinal system: Traditional use across Mediterranean cultures has included olive oil as a digestive aid and mild laxative. A dose of 30 mL of olive oil has been studied for constipation.
• Integumentary system (skin): The topical application of olive oil is effective and safe in reducing the incidence of pressure ulcers compared to other treatments.
• Liver: Both tyrosol and oleocanthal demonstrated antioxidant, anti-inflammatory, and lipid metabolism-modulating effects, which could mitigate chronic liver diseases such as metabolic-associated liver dysfunction and liver fibrosis.

7. Dosage Forms and Reported Dosages

Olive oil is consumed in several forms, including as a dietary food oil, as a dietary supplement in capsule or liquid form, and topically. The following dosages have been reported in research or regulatory contexts:

• EFSA-approved protective dose for LDL oxidation: An EFSA-approved health claim states that olive oil polyphenols contribute to the protection of blood lipids from oxidative stress. The claim may be used only for olive oil containing at least 5 mg of hydroxytyrosol and its derivatives (e.g., oleuropein complex and tyrosol) per 20 g of olive oil. The beneficial effect is obtained with a daily intake of 20 g of olive oil.
• Clinical trials for oxidative stress: A meta-analysis of high versus low polyphenol olive oil supplementation included 8 randomized clinical trials (N = 355) with daily intake of phenols ranging from 0 to 31 mg for durations ranging from 3 weeks to 3 months, with no reported safety issues.
• Blood pressure: 30–40 grams per day of extra-virgin olive oil as part of the diet has been used in research on high blood pressure.
• Constipation: 30 mL of olive oil has been studied for constipation.
• PREDIMED trial provision: In the PREDIMED study, 7,216 men and women at high cardiovascular risk were randomized to Mediterranean diets supplemented with extra-virgin olive oil (among other interventions) or a control low-fat diet. The PREDIMED-Plus protocol supplemented participants with approximately 50 mL of EVOO per day.

8. Safety Considerations and Interactions

General Tolerability

A meta-analysis of 8 randomized clinical trials involving olive oil polyphenol supplementation reported no safety issues across durations ranging from 3 weeks to 3 months. The European Food Safety Authority (EFSA) has extensively reviewed the safety data for olive oil polyphenols.

Interaction with Anticoagulant and Antiplatelet Medications

Olive oil may slow blood clotting. Taking olive oil along with medications that also slow clotting might increase the chances of bruising and bleeding. Medications with a potential interaction include aspirin, clopidogrel (Plavix), diclofenac, ibuprofen, naproxen, dalteparin, enoxaparin, heparin, and warfarin. This interaction is characterized as moderate and warrants attention in clinical settings.

Interaction with Antihypertensive Medications

In a clinical trial, daily antihypertensive drug dosage was significantly reduced during the extra-virgin olive oil (MUFA) diet compared with the sunflower oil (PUFA) diet (−48% vs −4%). All patients receiving the PUFA diet required antihypertensive treatment, whereas 8 of those receiving the MUFA diet needed no drug therapy. The mechanism is attributed to enhanced nitric oxide levels stimulated by polyphenols. This finding indicates that high EVOO intake may reduce antihypertensive medication requirements, a clinically significant interaction in managed hypertensive patients.

Polyphenol Content Variability

The EFSA document noted that concentrations in some olive oils may be too low to allow consumption of the 5 mg amount of hydroxytyrosol and its derivatives with a regular and balanced diet. The polyphenol content is determined by many factors including olive varietal: Koroneiki olives, for instance, have a very high level of polyphenols, while Arbequina's content is low.

Oxidation and Storage

Olive oils have been shown to be more resistant to oxidation than other vegetable fats, mainly due to their fatty acid profile rich in oleic acid and their high content of antioxidants, principally phenols and tocopherols. Phenols in olive oil decrease over time or when exposed to heat, oxygen, and light. Degradation of phenolic compounds during storage or cooking can substantially reduce the bioactive polyphenol content.

Caloric Considerations

As a fat-dense food, olive oil contains approximately 884 kcal per 100 g. In clinical trials, no adverse metabolic effects were attributed to EVOO intake at studied doses when integrated into a balanced diet; however, total caloric load should be considered when olive oil is introduced in large supplemental amounts.

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