Increase in RDA for Vitamin C Could Help Reduce Heart Disease, Stroke, Cancer

The recommended dietary allowance, or RDA, of vitamin C is less than half what it should be, scientists argue in a recent report, because medical experts insist on evaluating this natural, but critical nutrient in the same way they do pharmaceutical drugs and reach faulty conclusions as a result.

The researchers, in Critical Reviews in Food Science and Nutrition, say there’s compelling evidence that the RDA of vitamin C should be raised to 200 milligrams per day for adults, up from its current levels in the United States of 75 milligrams for women and 90 for men.

Rather than just prevent the vitamin C deficiency disease of scurvy, they say, it’s appropriate to seek optimum levels that will saturate cells and tissues, pose no risk, and may have significant effects on public health at almost no expense – about a penny a day if taken as a dietary supplement.

“It’s time to bring some common sense to this issue, look at the totality of the scientific evidence, and go beyond some clinical trials that are inherently flawed,” said Balz Frei, professor and director of the Linus Pauling Institute at Oregon State University, and one of the world’s leading experts on the role of vitamin C in optimum health.

“Significant numbers of people in the U.S. and around the world are deficient in vitamin C, and there’s growing evidence that more of this vitamin could help prevent chronic disease,” Frei said. “The way clinical researchers study micronutrients right now, with the same type of so-called ‘phase three randomized placebo-controlled trials’ used to test pharmaceutical drugs, almost ensures they will find no beneficial effect. We need to get past that.”

Unlike testing the safety or function of a prescription drug, the researchers said, such trials are ill suited to demonstrate the disease prevention capabilities of substances that are already present in the human body and required for normal metabolism. Some benefits of micronutrients in lowering chronic disease risk also show up only after many years or even decades of optimal consumption of vitamin C – a factor often not captured in shorter-term clinical studies.

A wider body of metabolic, pharmacokinetic, laboratory and demographic studies suggests just the opposite, that higher levels of vitamin C could help reduce the chronic diseases that today kill most people in the developed world – heart disease, stroke, cancer, and the underlying issues that lead to them, such as high blood pressure, chronic inflammation, poor immune response and atherosclerosis.

“We believe solid research shows the RDA should be increased,” Frei said. “And the benefit-to-risk ratio is very high. A 200 milligram intake of vitamin C on a daily basis poses absolutely no risk, but there is strong evidence it would provide multiple, substantial health benefits.”

An excellent diet with the recommended five to nine daily servings of fruits and raw or steam-cooked vegetables, together with a six-ounce glass of orange juice, could provide 200 milligrams of vitamin C a day. But most Americans and people around the world do not have an excellent diet.

Even at the current low RDAs, various studies in the U.S. and Canada have found that about a quarter to a third of people are marginally deficient in vitamin C, and up to 20 percent in some populations are severely deficient – including college students, who often have less-than-perfect diets. Smokers and older adults are also at significant risk.

Even marginal deficiency can lead to malaise, fatigue, and lethargy, researchers note. Healthier levels of vitamin C can enhance immune function, reduce inflammatory conditions such as atherosclerosis, and significantly lower blood pressure.

  • A recent analysis of 29 human studies concluded that daily supplements of 500 milligrams of vitamin C significantly reduced blood pressure, both systolic and diastolic. High blood pressure is a major risk factor for heart disease and stroke, and directly attributes to an estimated 400,000 deaths annually in the U.S.
  • A study in Europe of almost 20,000 men and women found that mortality from cardiovascular disease was 60 percent lower when comparing the blood plasma concentration of vitamin C in the highest 20 percent of people to the lowest 20 percent.
  • Another research effort found that men with the lowest serum vitamin C levels had a 62 percent higher risk of cancer-related death after a 12-16 year period, compared to those with the highest vitamin C levels.

Laboratory studies with animals – which may be more accurate than human studies because they can be done in controlled conditions and with animals of identical genetic makeup – can document reasons that could explain all of these findings, Frei said.

Critics have suggested that some of these differences are simply due to better overall diet, not vitamin C levels, but the scientists noted in this report that some health benefits correlate even more strongly to vitamin C plasma levels than fruit and vegetable consumption.

Scientists in France and Denmark collaborated on this report. Research at OSU on these issues has been supported by the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health.

 

Reference 

Frei B, Birlouez-Aragon I, Lykkesfeldt J. Authors’ Perspective: What is the Optimum Intake of Vitamin C in Humans? Crit Rev Food Sci Nutr 2012; 52 (9): 815-29.

 

Role of Mercury Toxicity in Hypertension, Cardiovascular Disease, and Stroke

Dr. Mark C. Houston is Associate Clinical Professor of Medicine at Vanderbilt University School of Medicine and Director of the Hypertension Institute at Saint Thomas Hospital in Nashville, TN. He has written an important review article on the cardiovascular consequences of mercury exposure in humans. The article discusses how mercury toxicity in humans is related to hypertension, generalized atherosclerosis, coronary heart disease (CHD), myocardial infarction (MI), cardiac arrhythmias, heart rate variability, sudden death, cerebrovascular accidents (CVA), carotid artery disease, renal dysfunction, and total mortality.

 

Mark C. Houston

Role of Mercury Toxicity in Hypertension, Cardiovascular Disease, and Stroke
J Clin Hypertens (Greenwich) 2011; 13 (8): 621-7

 

ABSTRACT

Mercury has a high affinity for sulfhydryl groups, inactivating numerous enzymatic reactions, amino acids, and sulfur-containing antioxidants (N-acetyl-L-cysteine, alpha-lipoic acid, L-glutathione), with subsequent decreased oxidant defense and increased oxidative stress. Mercury binds to metallothionein and substitute for zinc, copper, and other trace metals, reducing the effectiveness of metalloenzymes. Mercury induces mitochondrial dysfunction with reduction in adenosine triphosphate, depletion of glutathione, and increased lipid peroxidation. Increased oxidative stress and reduced oxidative defense are common. Selenium and fish containing omega-3 fatty acids antagonize mercury toxicity. The overall vascular effects of mercury include increased oxidative stress and inflammation, reduced oxidative defense, thrombosis, vascular smooth muscle dysfunction, endothelial dysfunction, dyslipidemia, and immune and mitochondrial dysfunction. The clinical consequences of mercury toxicity include hypertension, coronary heart disease, myocardial infarction, cardiac arrhythmias, reduced heart rate variability, increased carotid intima-media thickness and carotid artery obstruction, cerebrovascular accident, generalized atherosclerosis, and renal dysfunction, insufficiency, and proteinuria. Pathological, biochemical, and functional medicine correlations are significant and logical. Mercury diminishes the protective effect of fish and omega-3 fatty acids. Mercury inactivates catecholaminei-0-methyl transferase, which increases serum and urinary epinephrine, norepinephrine, and dopamine. This effect will increase blood pressure and may be a clinical clue to mercury-induced heavy metal toxicity. Mercury toxicity should be evaluated in any patient with hypertension, coronary heart disease, cerebral vascular disease, cerebrovascular accident, or other vascular disease. Specific testing for acute and chronic toxicity and total body burden using hair, toenail, urine, and serum should be performed.

 

Forks Over Knives

What has happened to us? Despite the most advanced medical technology in the world, we are sicker than ever by nearly every measure. Cases of diabetes are exploding, especially amongst our younger population. About half of us are taking at least one prescription drug and major medical operations have become routine.  Heart disease, cancer and stroke are the three leading causes of death in the USA, even though billions are spent each year to “battle” these very conditions.  Millions suffer from a host of other degenerative diseases.

Could it be there’s a single solution to all of these problems? A solution so comprehensive but so straightforward, that it’s mind-boggling that more of us haven’t taken it seriously?

Forks Over Knives (2010) examines the profound claim that most, if not all, of the socalled “diseases of affluence” that afflict us can be controlled, or even reversed, by rejecting our present menu of animal-based and processed foods.  The major storyline in the film traces the personal journeys of Dr. T. Colin Campbell, a nutritional scientist from Cornell University, and Dr. Caldwell Esselstyn, a former top surgeon at the world renowned Cleveland Clinic.

Inspired by remarkable discoveries in their young careers, these men conducted several groundbreaking studies, one of which took place in China and is considered among the most comprehensive health-related investigations ever undertaken.  Their separate research led them to the same startling conclusion: degenerative diseases like heart disease, type 2 diabetes, and even several forms of cancer, could almost always be prevented—and in many cases reversed—by adopting a whole foods, plant-based diet. Despite the profound implications of their findings, their work has remained relatively unknown to the public.

In addition, cameras follow “reality patients” who have chronic conditions from heart disease to diabetes.  Doctors teach these patients how to adopt a whole foods plantbased diet as the primary approach to treat their ailments—while the challenges and triumphs of their journeys are revealed.

The film features leading experts on health and tackles the issue of diet and disease in a way that will have people talking for years. Read More

 

Watch the full documentary

An Apple or Pear a Day May Keep Strokes Away

Apples and pears may keep strokes away. That’s the conclusion of a Dutch study published in Stroke: Journal of the American Heart Association in which researchers found that eating a lot of fruits and vegetables with white flesh may protect against stroke.

While previous studies have linked high consumption of fruits and vegetables with lower stroke risk, the researchers’ prospective work is the first to examine associations of fruits and vegetable color groups with stroke.

The color of the edible portion of fruits and vegetables reflects the presence of beneficial phytochemicals such as carotenoids and flavonoids.

Researchers examined the link between fruits and vegetable color group consumption with 10-year stroke incidence in a population-based study of 20,069 adults, with an average age of 41. The participants were free of cardiovascular diseases at the start of the study and completed a 178-item food frequency questionnaire for the previous year.

Fruits and vegetables were classified in four color groups:

  • Green, including dark leafy vegetables, cabbages and lettuces
  • Orange/Yellow, which were mostly citrus fruits
  • Red/Purple, which were mostly red vegetables
  • White, of which 55 percent were apples and pears

 

During 10 years of follow-up, 233 strokes were documented. Green, orange/yellow and red/purple fruits and vegetables weren’t related to stroke. However, the risk of stroke incidence was 52 percent lower for people with a high intake of white fruits and vegetables compared to people with a low intake.

Each 25 gram per day increase in white fruits and vegetable consumption was associated with a 9 percent lower risk of stroke. An average apple is 120 grams.

“To prevent stroke, it may be useful to consume considerable amounts of white fruits and vegetables,” said Linda M. Oude Griep, M.Sc., lead author of the study and a postdoctoral fellow in human nutrition at Wageningen Uninversity in the Netherlands. “For example, eating one apple a day is an easy way to increase white fruits and vegetable intake.

“However, other fruits and vegetable color groups may protect against other chronic diseases. Therefore, it remains of importance to consume a lot of fruits and vegetables.”

Apples and pears are high in dietary fiber and a flavonoid called quercetin. In the study, other foods in the white category were bananas, cauliflower, chicory and cucumber.

Potatoes were classified as a starch.

Previous research on the preventive health benefits of fruits and vegetables focused on the food’s unique nutritional value and characteristics, such as the edible part of the plant, color, botanical family and its ability to provide antioxidants.

U.S. federal dietary guidelines include using color to assign nutritional value. The U.S. Preventive Health Services Taskforce recommends selecting each day vegetables from five subgroups: dark green, red/orange, legume, starchy and other vegetables.

Before the results are adopted into everyday practice, the findings should be confirmed through additional research, Oude Griep said. “It may be too early for physicians to advise patients to change their dietary habits based on these initial findings,” she said.

An accompanying editorial notes that the finding should be interpreted with caution because food frequency questionnaires may not be reliable.

In addition, “the observed reduction in stroke risk might further be due to a generally healthier lifestyle of individuals consuming a diet rich in fruits and vegetables,” writes Heike Wersching, M.D., M.Sc., of Institute of Epidemiology and Social Medicine at the University of Münster, in Germany.

 

Reference 

Griep LM, Verschuren WM, Kromhout D, Ocké MC, Geleijnse JM. Raw and processed fruit and vegetable consumption and 10-year stroke incidence in a population-based cohort study in the Netherlands. Eur J Clin Nutr 2011; 65 (7): 791-9.

 

It’s Official — Chocolate Linked To Heart Health

Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis.

High levels of chocolate consumption might be associated with a one third reduction in the risk of developing heart disease, finds a study published on bmj.com.

The findings confirm results of existing studies that generally agree on a potential beneficial link between chocolate consumption and heart health. However, the authors stress that further studies are now needed to test whether chocolate actually causes this reduction or if it can be explained by some other unmeasured (confounding) factor.

The World Health Organisation predicts that by 2030, nearly 23.6 million people will die from heart disease. However, lifestyle and diet are key factors in preventing heart disease, says the paper.

A number of recent studies have shown that eating chocolate has a positive influence on human health due to its antioxidant and anti-inflammatory properties. This includes reducing blood pressure and improving insulin sensitivity (a stage in the development of diabetes).

However, the evidence about how eating chocolate affects your heart still remains unclear. So, Dr Oscar Franco and colleagues from the University of Cambridge carried out a large scale review of the existing evidence to evaluate the effects of eating chocolate on cardiovascular events like heart attack and stroke.

They analysed the results of seven studies, involving over 100,000 participants with and without existing heart disease. For each study, they compared the group with the highest chocolate consumption against the group with the lowest consumption. Differences in study design and quality were also taken into account to minimise bias.

Five studies reported a beneficial link between higher levels of chocolate consumption and the risk of cardiovascular events and they found that the “highest levels of chocolate consumption were associated with a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared with lowest levels.” No significant reduction was found in relation to heart failure.

The studies did not differentiate between dark or milk chocolate and included consumption of chocolate bars, drinks, biscuits and desserts.

The authors say the findings need to be interpreted with caution, in particular because commercially available chocolate is very calorific (around 500 calories for every 100 grams) and eating too much of it could in itself lead to weight gain, risk of diabetes and heart disease.

However, they conclude that, given the health benefits of eating chocolate, initiatives to reduce the current fat and sugar content in most chocolate products should be explored.

 

Reference

Buitrago-Lopez A, Sanderson J, Johnson L, Warnakula S, Wood A, Di Angelantonio E, Franco OH. Chocolate consumption and cardiometabolic disorders: systematic review and meta-analysis. BMJ 2011; 343: d4488.

 

Omega-3s Reduce Stroke Severity

A diet rich in omega-3s reduces the severity of brain damage after a stroke, according to a study conducted by Université Laval researchers. The team, co-directed by professors Jasna Kriz and Frédéric Calon, showed that the extent of brain damage following a stroke was reduced by 25% in mice that consumed DHA type omega-3s daily. Details of the study can be found on the website of the journal Stroke.

Researchers observed that the effects of stroke were less severe in mice that had been fed a diet rich in DHA for three months than in mice fed a control diet. In mice from the DHA group, they saw a reduction in the concentrations of molecules that stimulate tissue inflammation and, conversely, a larger quantity of molecules that prevent the activation of cell death.

“This is the first convincing demonstration of the powerful anti-inflammatory effect of DHA in the brain,” underscored Frédéric Calon of Université Laval’s Faculty of Pharmacy. This protective effect results from the substitution of molecules in the neuronal membrane: DHA partially replaces arachidonic acid, an omega-6 fatty acid known for its inflammatory properties.

“The consumption of omega-3s creates an anti-inflammatory and neuroprotective environment in the brain that mitigates damage following a stroke,” summarized Jasna Kriz, of Université Laval’s Faculty of Medicine. “It prevents an acute inflammatory response that, if not controlled, is harmful to brain tissue.”

Professor Calon believes that this anti-inflammatory effect is likely transferable to humans. “Since DHA is readily available, inexpensive, and reduces the risk of a number of health problems without causing significant side effects, the risk–benefit ratio tends to favor the regular consumption of fish or DHA,” he concluded.

 

Reference 

Lalancette-Hébert M, Julien C, Cordeau P, Bohacek I, Weng YC, Calon F, Kriz J. Accumulation of Dietary Docosahexaenoic Acid in the Brain Attenuates Acute Immune Response and Development of Postischemic Neuronal Damage. Stroke 2011 Aug 18. [Epub ahead of print].

 

High Potassium Intake Linked With Lower Risk Of Stroke, Especially Ischemic Stroke

Susanna C. Larsson, Ph.D.

Researchers at Karolinska Institutet in Stockholm have found that dietary potassium intake is inversely associated with risk of stroke, in particular ischemic stroke. A higher intake of potassium (1000 mg) compared to a lower intake was associated with as much as 11 percent reduction in the ischemic stroke risk, 5 percent reduction in intracerebral hemorrhage, but 8 percent increase in the risk of subarachnoid hemorrhage. The study was based on data from prospective studies of 268,276 participants with 8695 cases of stroke reported in Pubmed database from Januar 1966 through March 2011.

 

Larsson SC, Orsini N, Wolk A.

Dietary Potassium Intake and Risk of Stroke: A Dose-Response Meta-Analysis of Prospective Studies.
Stroke. 2011 Jul 28. [Epub ahead of print]


Abstract

Background and Purpose:
Potassium intake has been inconsistently associated with risk of stroke. Our aim was to conduct a meta-analysis of prospective studies to assess the relation between potassium intake and stroke risk.

Methods:
Pertinent studies were identified by a search of PubMed from January 1966 through March 2011 and by reviewing the reference lists of retrieved articles. We included prospective studies that reported relative risks with 95% CIs of stroke for ≥3 categories of potassium intake or for potassium intake analyzed as a continuous variable. Study-specific results were pooled using a random-effects model.

Results:
Ten independent prospective studies, with a total of 8695 stroke cases and 268 276 participants, were included in the meta-analysis. We observed a statistically significant inverse association between potassium intake and risk of stroke. For every 1000-mg/day increase in potassium intake, the risk of stroke decreased by 11% (pooled relative risk, 0.89; 95% CI, 0.83 to 0.97). In the 5 studies that reported results for stroke subtypes, the pooled relative risks were 0.89 (95% CI, 0.81 to 0.97) for ischemic stroke, 0.95 (95% CI, 0.83 to 1.09) for intracerebral hemorrhage, and 1.08 (95% CI, 0.92 to 1.27) for subarachnoid hemorrhage.

Conclusions:
Dietary potassium intake is inversely associated with risk of stroke, in particular ischemic stroke.

 

‘Gifted’ Natural Vitamin E Tocotrienol Protects Brain Against Stroke In 3 Ways

COLUMBUS, Ohio – A natural form of vitamin E called alpha-tocotrienol can trigger production of a protein in the brain that clears toxins from nerve cells, preventing those cells from dying after a stroke, new research shows.

This process is one of three mechanisms identified so far that this form of vitamin E uses to protect brain cells after a stroke, meaning that this natural substance might be more potent than drugs targeting single mechanisms for preventing stroke damage, according to Ohio State University scientists who have studied the nutrient for more than a decade.

These researchers previously reported that the tocotrienol form of vitamin E protects the brain after a stroke by blocking an enzyme from releasing toxic fatty acids and inhibiting activity of a gene that can lead to neuron death.

Vitamin E occurs naturally in eight different forms, and all of this work is focused on the tocotrienol form, also known as TCT. The commonly known form of vitamin E belongs to a variety called tocopherols. TCT is not abundant in the American diet but is available as a nutritional supplement. It is a common component of a typical Southeast Asian diet.

In this new study, the researchers first clarified the role of a protein called MRP1, or multidrug resistance-associated protein 1. This protein clears away a compound that can cause toxicity and cell death when it builds up in neurons as a result of the trauma of blocked blood flow associated with a stroke.

They then determined that TCT taken orally influences production of this protein by elevating the activity of genes that make MRP1. This appears to occur at the microRNA level; a microRNA is a small segment of RNA that influences a gene’s protein-building function.

This is one of the first studies to provide evidence that a safe nutrient – a vitamin – can alter microRNA biology to produce a favorable disease outcome,” said Chandan Sen, professor and vice chair for research in Ohio State’s Department of Surgery and senior author of the study. “Here, a natural nutritional product is simultaneously acting on multiple targets to help prevent stroke-induced brain damage. That is a gifted molecule.”

The research appears online and is scheduled for later print publication in the journal Stroke.

Over the past decade, Sen has led numerous studies on how the TCT form of vitamin E protects the brain against stroke damage in animal and cell models, and intends to eventually pursue tests of its potential to both prevent and treat strokes in humans. Approximately 795,000 Americans suffer new or recurrent strokes each year, and stroke is the third-leading cause of death in the United States, according to the American Stroke Association.

These latest research findings in mice follow a recent Food and Drug Administration certification of TCT as “Generally Recognized as Safe.” The scientists conclude in the paper that even before clinical trials can take place, “TCT may be considered as a preventive nutritional countermeasure for people at high risk for stroke.”

To determine the role of MRP1 in protecting brain cells, the researchers compared the effects of an induced stroke in two groups of mice: normal mice and animals that were genetically modified to be deficient in the MRP1 protein.

Both groups of mice showed comparably decreased blood flow in the area of the stroke, but the mice deficient in MRP1 had a larger volume of tissue death than did normal mice.

The mice with the protein deficiency also had a 1.6-fold higher level of a toxin that is cleared by MRP1. This toxin is called GSSG, or glutathione disulfide, and these researchers have previously shown that a failure to clear this toxin appears to trigger neuron death in the brain after stroke.

“The protein has the effect of dredging out the toxin,” said Sen, who is also a deputy director of Ohio State’s Davis Heart and Lung Research Institute. “A significant finding in this work is the recognition that MRP1 is a protective factor against stroke. Thanks to tocotrienol, we were able to identify that path.”

The presence of GSSG is linked to an excessive amount of glutamate that is released in the brain after a stroke. Glutamate is a neurotransmitter that, in tiny amounts, has important roles in learning and memory. Too much of it triggers a sequence of reactions that lead to the death of brain cells – the most damaging effects of a stroke.

This experiment showed for the first time that the loss of MRP1 function impairs the clearance of GSSG, and that MRP1 cells were recruited to the site of the stroke in normal mice, indicating this protein has a protective role in the brain after a stroke.

The researchers searched databases containing genomic data for a microRNA that appeared to have potential to influence production of MRP1. MicroRNAs bind to messenger RNA, which contains the actual set of instructions for building proteins. When that connection is made, however, the microRNA inhibits the building of protein from messenger RNA. So an inverse relationship exists between a microRNA and a protein it controls.

The researchers saw this very relationship in the cell study in which they manipulated the candidate microRNA levels and observed the effects of changing those levels on the presence of the MRP1 protein.

Finally, the researchers compared mice that were treated with TCT supplements or corn oil as a control for 13 weeks before a stroke was induced. The amount of damaged brain tissue was smaller in the mice that received TCT supplementation than in the mice receiving corn oil. In addition, TCT supplementation was associated with a lower level of the candidate microRNA in the damaged brain tissue, as well as an increase in the abundance of MRP1 cells at the stroke site.

“Essentially what we are showing with mechanistic explanation is that tocotrienol protects neural cells. It is anti-neurodegenerative,” Sen said. “This form of vitamin E helped us identify three major checkpoints in stroke-related neurodegeneration that were not known before we began testing tocotrienols against neurodegeneration”
Reference
Park HA, Kubicki N, Gnyawali S, Chan YC, Roy S, Khanna S, Sen CK. Natural Vitamin E α-Tocotrienol Protects Against Ischemic Stroke by Induction of Multidrug Resistance-Associated Protein 1. Stroke. 2011 Jun 30. [Epub ahead of print].

 

Using Olive Oil In Your Diet May Prevent A Stroke

A new study suggests that consuming olive oil may help prevent a stroke in older people. The research is published in the June 15, 2011, online issue of Neurology, the medical journal of the American Academy of Neurology.

“Our research suggests that a new set of dietary recommendations should be issued to prevent stroke in people 65 and older,” said study author Cécilia Samieri, PhD, with the University of Bordeaux and the National Institute of Health and Medical Research (INSERM) in Bordeaux, France. “Stroke is so common in older people and olive oil would be an inexpensive and easy way to help prevent it.”

For the study, researchers looked at the medical records of 7,625 people ages 65 and older from three cities in France: Bordeaux, Dijon and Montpellier. Participants had no history of stroke. Olive oil consumption was categorized as “no use,” “moderate use” such as using olive oil in cooking or as dressing or with bread, and “intensive use,” which included using olive oil for both cooking and as dressing or with bread. Samieri said the study participants mainly used extra virgin olive oil, as that is 98 percent of what is available in France.

After a little over five years, there were 148 strokes.

After considering diet, physical activity, body mass index and other risk factors for stroke, the study found that those who regularly used olive oil for both cooking and as dressing had a 41 percent lower risk of stroke compared to those who never used olive oil in their diet (1.5 percent in six years compared to 2.6 percent).

Olive oil has been associated with potentially protective effects against many cardiovascular risk factors, such as diabetes, high blood pressure, high cholesterol and obesity. In an accompanying editorial, Nikolaos Scarmeas, MD, of Columbia University and a member of the American Academy of Neurology noted that it is not clear which particular elements of olive oil could be protective, while the effects of olive oil could even be indirect by making other healthy foods tastier. He also cautioned that only future clinical trials can increase confidence in the findings and potentially lead to stroke prevention recommendations.