Broccoli Prevents Cancer

Broccoli Prevents Cancer

 

In the Journal of Nutritional Biochemistry, a new study shows that sulforaphane from broccoli may have a positive impact on genetics and prostate cancer risk.(1)  Prostate cancer is the second leading cause of death in men in the US and more targeted preventative strategies are needed.

What is sulforaphane? Sulforaphane is a major phytochemical found in cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, brussel sprouts, radishes and others.  The highest concentration is found in broccoli sprouts.  Sulforaphane is formed when an enzyme myrosinase helps to break down glucoraphanin, a glucosinolate, into sulforaphane during the chewing phase of digestion.

Phytochemicals like sulforaphane can act as a protectant to our cells.  It’s a cell’s primary defensive system.  Sulforaphane has been shown in other research to have anticancer effects.(2) So far, sulforaphane has been shown to exert it’s positive effects through the activation of Nrf2 signaling pathway.(3) This study provides another pathway through which sulforaphane exerts its potent cancer protective effects.

The recent paper mentioned above explains that researchers recognized a pathway where sulforaphane can affect long, non-coding RNAs. Ribonucleic acids (RNA) are long molecular chains responsible for transmitting genetic material.  RNAs are crucial for cellular growth and can be negatively expressed, which can trigger chronic diseases like cancer.

Ingesting sulforaphane positively expresses your genes by decreasing the long non-coding RNA four fold, thereby normalizing it during upregulation in prostate cancer, possibly preventing the progression of cancer and in some cases preventing it altogether.  It turns out that the current kale craze may not be so crazy after all.  Or maybe we are going to see a broccoli sprouts craze! Break out your gas mask.

You should include cruciferous vegetables like broccoli and kale in your daily diet and you should also consider adding a sulforaphane supplement from broccoli sprouts.  Most broccoli sprout supplements contain glucoraphanin, but this still has to be converted by the body into sulforaphane.  Metagenics has developed a nutraceutical product called SulforaClear that not only contains 204 mg of the powerful phytochemical, sulforaphane, but it also contains the myrosinase enzyme, derived from the broccoli florets, which facilitates the production of the active ingredient in the body.   Sulforaphane should be part of your anti-cancer regimen, esp. if you have a family history or a genetic profile that increases your cancer risk.

 

References:

  1. Beavera LM, Kuintzlec R, Buchanan A, et al. Long noncoding RNAs and sulforaphane: a target for chemoprevention and suppression of prostate cancer. Journal of Nutritional Biochemistry 42 (2017) 72–83.
  2. Zhang Y, Talalay P, Cho C, Posner G. A major inducer of anticarcinogenic protective enzymes from broccoli: Isolation and elucidation of structure. Proc. Natl. Acad. Sci. 1992; (89), 2399-2403.
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4789124/

 

 

Removing Toxins With Proper Liver Support

Our modern world is awash in toxins, including heavy metals (lead, mercury, cadmium, arsenic), herbicides, pesticides, teflon pans, BPA from plastic, pthalates and sodium laurel sulfate in personal care products, flame retardant chemicals found in furniture, chlorine, flouride, and ammonia added to our drinking water, chemicals from paints and other building materials, etc..

Many of these toxins become stored in our fatty tissues. In order to remove stored toxins, your body needs to convert these fat soluble chemicals into water soluble ones that can be excreted through the stool, urine, or sweat. This process occurs primarily in the liver, so you need to conduct a proper liver detoxification program. This can be done by providing specific nutritional support for both Phase I and Phase II enzymes of the liver detoxification process. Phase I is conducted by the cytochrome P450 family of enzymes that take the fat soluble toxins and add a reactive group as part of the detoxification process. These reactions include oxidation, reduction, and hydrolysis.  If you can drink several cups of coffee in the afternoon or evening and sleep fine, then your phase I enzymes are likely overactive. The Phase I enzymes actually temporarily creates more reactive molecules that, if not converted fully into water soluble metabolites by Phase II, could lead to detoxification reactions, such as headache, brain fog, stomach aches, constipation or diarrhea, skin breakouts, fatigue and low energy, sleep problems, irritability, and congestion. This is why a juice fast is not as effective as using specific nutrients that support Phase II of liver detoxification.

Phase II of liver detoxification is crucial for proper removal of toxins from the body and a juice fast is liable to lead to depressed phase II enzymes, since amino acids are important nutrients for this phase and juices contain no amino acids. Phase II of liver detoxification is also known as the conjugation phase, since these toxins are congugated or combined with another substance, such as cysteine, glycine, or a sulfur molecule to make it water soluble, so it can be excreted from the body.  A proper detoxification program should include phase II supportive nutrients, such as amino acids like glutamine, glycine, and sulfur containing amino acids like taurine and cysteine.  It should also include cruciferous vegetables, like broccoli and watercress.  Likewise, it is important that you have a daily bowel movement so that toxins in the stool get eliminated, so support for the digestive tract such as probiotics or magnesium supplements as a stool softener may be indicated.  In addition, drinking a lot of water to support the kidneys and urine flow and sweating is important, since these are other routes for toxin removal.  Speak to Dr. Weitz for help with nutritional support for detoxification and consider attending the free detoxification that Dr. Weitz is giving in the office on February 2 Thursday at 6pm.  Call the front desk for more information or to add your name to the list.

Main reference: Hodges R, Fitzgerald KN The Detoxification Module of The Clinical Nutrition Series from The Board for Certification of Nutrition Specialists from the MHICN http://healthcareinstituteforclinicalnutrition.com/wp-content/uploads/2016/09/Detoxifcation-Module_F2_mh.pdf

Omega 3, Vitamin D, and Resveratrol Supplements May Benefit Preclinical Alzheimer’s Disease

Alzheimer’s Disease is a neurodegenerative disease where the patient experiences progressive loss of normal brain function and it is the cause of 60 to 70% of cases of dementia. After the diagnosis of Alzheimer’s Disease, the average patient only lives 3 to 9 years, so treatments to slow down the progression or reverse the condition are sorely needed. Alzheimer’s Disease is marked by plaques that build up in the brain that contain abnormally folded Amyloid beta (A beta) protein. If the body is not able to clear these proteins out of the brain, they build up and lead to deterioration of brain function.

UCLA neurologists, including Dale Bredesen, found that supplementing preclinical patients with Alzheimer’s Disease with an Omega 3 drink that also contained vitamin D and resveratrol was beneficial. These patients, with mild cognitive impairment, experienced an increase in the breakdown (phagocytosis) of the neurotoxic molecule, amyloid Beta. Therapies that promote clearance of this molecule have been the focus of much research on Alzheimer’s.

In patients with mild clinical impairment and pre-mild clinical impairment who took the omega 3, vitamin D and reveratrol, phagocytosis of amyloid-beta by monocytes increased from 530 to 1306 mean fluorescence intensity units. Unfortunately, once the patients already had Alzheimer’s Disease, it did not help that much. The lipidic mediator resolvin D1, which stimulates amyloid-beta phagocytosis in vitro, increased in macrophages in 80% of patients with mild clinical impairment and pre-mild clinical impairment.

Omega 3 fatty acids both reduce inflammation and through the formation of Specialized Pro-Resolving Mediators (SPM), which have been shown to resolve inflammation, protect organs, and stimulate tissue regeneration.(2) According to these UCLA neurologists, “SPMs from omega-3s are known to terminate acute inflammation, increase phagocytosis, and have distinct roles in attenuating chronic inflammation and, thus, appear suitable for repairing defective Ab phagocytosis and regulating inflammation in patients with Alzheimer’s Disease. Interestingly, the Alzheimer’s Disease brain was found to have defective SPMs in the hippocampus.”

Readers should keep in mind that this was a small study and such results are interesting, but by no means are definitive without larger studies. It is also interesting to consider that SPMs are now available as separate supplements from Metagenics and sold at our office. I recommend supplementing with both omega 3 fats from fish oil capsules as well as SPMs to further protect brain tissue from possible deterioration with autoimmune diseases (like Alzheimer’s and Parkinson’s) or degenerative diseases (like senile dementia). Speak to Dr. Weitz about this. Also, we can help you get tested for the ApoE gene that tells you whether you are at higher risk for this condition.

References:
1. Fiala M, Halder RC, Sagong B, Ross O, Sayre J, Porter V, Bredesen DE. “[Omega]-3 Supplementation increases amyloid-[beta] phagocytosis and resolvin D1 in patients with minor cognitive impairment.” FASEB J. 2015 Jul;29(7):2681-9.
http://www.fasebj.org/content/29/7/2681.full.pdf+html
2. Spite, M., Claria, J., and Serhan, C. N. (2014) Resolvins, ` specialized proresolving lipid mediators, and their potential roles in metabolic diseases. Cell Metab. 19, 21-36.

Calcium Supplements Do Not Cause Heart Disease

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I was very skeptical of the studies that seemed to show that taking calcium supplements or consuming calcium would lead to calcium buildup in the arteries and contribute to heart disease. Calcium is an essential mineral in the body that is essential in cellular metabolism as a signaling molecule and important for the strength of our teeth and bones, and most Americans are lacking adequate levels. I discussed this in a video recorded 3 years ago. watch video here But at the time, several studies were published that seemed to show that excessive calcium intake, esp. from supplements, would get deposited in the arteries and contributed to atherosclerosis and heart disease.(1,2,3,4) This led many doctors to stop recommending calcium supplements. I think this was a great disservice to many patients who needlessly lost bone mass because of this advice. Let’s not forget the significance of osteoporosis and osteopenia in the US. Over 54 million Americans suffer with bone loss and one in two women and one in four men over the age of 50 will break a bone related to osteoporosis, according to The National Osteoporosis Foundation. The US spends 19 billion dollars per year for health care costs related to such fractures.

There is no physiological reason why simply having more calcium would lead to it getting deposited in the arteries. It is oxidized lipids in the presence of inflammation in the arterial walls that results in plaque formation. There is always sufficient calcium in the blood stream to form plaques and increasing the amount of calcium is unlikely to play any role in this process. Granted, there are negative effects of overconsuming poorly absorbable forms of calcium, such as the calcium carbonate found in Tums, resulting in Milk Alkali Syndrome (5) Equally important is that the patient consume optimal levels of magnesium, vitamin D3, and vitamin K, preferably MK7, to facilitate the utilization of the calcium and bone formation. Further, in patients with normal kidney function, the body is able to excrete a reasonable amount of excess calcium fairly easily without consequence.

Recently a review and meta-analysis published in the Annals of Internal Medicine concluded that “Calcium intake within tolerable upper intake levels (2000 to 2500 mg/d) is not associated with CVD risk in generally healthy adults.” In fact, with the highest calcium intake (greater than or equal to 1453 mg daily) compared to the lowest intake (less than 434 mg), there was a 27% decreased risk of coronary artery calcium, that is, in the amount of atherosclerotic plaque formation in their arteries. This led the American Society for Preventative Cardiology and the National Osteoporosis Foundation to conclude that calcium supplements in dosages up to 2500 mg/day do not increase the risk of heart attacks, strokes or cardiovascular disease.(6,7) The authors of this paper did separate out the supplement users from the calcium from food and did see some increase CVD from supplements but not from food. However, this was with smaller supplement amounts and not with larger amounts of supplements, which really doesn’t make any sense. And once again, those subjects who had the largest intake of calcium from a combination of food and supplements had a lower risk, so it is hard to understand how taking supplements, unless they were of very poor quality, could pose any risk. My conclusion from this and the other studies is that reasonable amounts of quality calcium supplements are safe and do not contribute to heart disease. To make sure the calcium is utilized by the body for bone formation and its other functions, make sure to take a quality form like calcium citrate, malate, or hydroxyapatite, and take it with magnesium, vitamin C, vitamin D3, and vitamin K2-MK7 and keep your total intake from both food and supplements under 2500 mg/day.

 

References:
1. Bolland MJ, Avenell A, et al.. Effect of calcium supplements on risk of myocardial infarction and cardiovascular events: meta-analysis. BMJ. 2010;341:c3691.
2. Bolland MJ, Grey A, Avenell A, Gamble GD, Reid IR. Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis. BMJ. 2011;342:d2040.
3. Reid IR, Bristow SM, Bolland MJ. Cardiovascular complications of calcium supplements. J Cell Biochem. 2015;116:494–501.
4. Xiao Q, Murphy RA, Houston DK, et al. Dietary calcium and supplemental calcium intak and cardiovascular disease mortality: The National Institutes of Health—AARP diet and health study. JAMA Intern Med. 2013;173(8):639-46.
5. Felsenfeld AJ, Levine BS. Milk alkalai syndrome and the dynamics of calcium homeostasis. Clin J Am Soc Nephrol; 2006. 1(4):641-54.
6. Chung M, Tang AM, Fu Z, Wang DD, Newberry SJ. Calcium Intake and Cardiovascular Disease Risk: An Updated Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 25 October 2016] doi: 10.7326/M16-1165
7. Kopecky SL, Bauer DC, Gulati M, et al. Lack of evidence linking calcium with or without vitamin D supplementation to cardiovascular disease in generally healthy adults: A clinical guideline from the National Osteoporosis Foundation and the American Society for Preventive Cardiology. Ann Intern Med. [Epub ahead of print 25 October 2016] doi: 10.7326/M16-1743
8. Nutrition Action Newsletter, December 2016.

How to Avoid a Food Hangover on Thanksgiving

Of course, Thanksgiving is a time to give thanks and enjoy a good meal. But that’s no reason to eat yourself to oblivion to where you can barely move for hours and to where you have a food hangover. So here are some common sense tips for under-indulging yourself and making your Thanksgiving day healthier:

1. Make sure to have a healthy breakfast to start the day. Don’t go into your Thanksgiving meal starving.
2. Go to the gym or do some exercise in the morning if possible. Maybe plan a soccer or basketball game with the kids early in the day.
3. For before dinner snacks, go for the veggies and dip or salad if available.
4. Fill 1/4 of your plate with turkey. Fill 1/2 your plate with as many veggies as possible–brussel sprouts, green beans, carrots, etc. Fill the last 1/4 of your plate with the rest of the goodies–sweet potatoes, etc. But only have one plate.
5. Eat slowly and savor every bite of food. Place your fork down between bites.
6. Let yourself have one glass of wine or other beverage. Have at least one glass of water prior to starting dinner to reduce your appetite
6. Let yourself have one small slice of pie, but no more.
7. Consider getting some family members to go out for a walk after dinner.

Healthy Thanksgiving Side Alternatives

Cranberry Sauce with Apricots, Raisins, and Orangecranberry-sauce

Prep Time: 10 Minutes
Cook Time: 15 Minutes
Ready In: 8 Hours 25 Minutes
Servings: 24

“Dried apricots are a great addition to this holiday favorite!”

INGREDIENTS:
1 cup orange juice
1 cup water
4 cups fresh cranberries
3/4 cup sugar
1 cup chopped dried apricots
1 cup golden raisins
1 tablespoon grated orange zest

DIRECTIONS:
In a large saucepan over medium heat, mix the orange juice, water, cranberries, sugar, apricots, raisins, and orange zest. Stir constantly until sugar has dissolved, about 5 minutes. Bring to a boil, and cook 10 minutes, or until cranberries have burst. Remove from heat, and chill at least 8 hours, or overnight, before serving cold.

Baked Sweet Potatoes with Ginger and Honey

Prep Time: 15 Minutes
Cook Time: 40 Minutes
Ready In: 55 Minutes
Servings: 12
“Fresh ginger, cardamom, and sweet potatoes will fill your house with a fall fragrance as well as call your family to the table. Originally submitted to ThanksgivingRecipe.com.”
INGREDIENTS:
3 pounds sweet potatoes, peeled and
cubed
1/2 cup honey
3 tablespoons grated fresh ginger
2 tablespoons walnut oil
1 teaspoon ground cardamom
1/2 teaspoon ground black pepper

DIRECTIONS:

Preheat oven to 400 degrees F (200 degrees C).
In a large bowl, toss together the sweet potatoes, honey, ginger, walnut oil, cardamom, and pepper. Transfer to a large cast iron frying pan.
Bake for 20 minutes in the preheated oven. Stir the potatoes to expose the pieces from the bottom of the pan. Bake for another 20 minutes, or until the sweet potatoes are tender and caramelized on the outside.

Healthy Alternatives to Traditional Thanksgiving Stuffing

1. Eggplant and Mushroom Casserole: Eggplant and mushrooms are not only rich in fiber, therefore helping to make the casserole a very filling side dish, but also contain a number of healthful vitamins and nutrients that make this dish a great addition to any table.  To make an eggplant and mushroom casserole, start by using a sharp knife to cut the vegetables into pieces which are all roughly the same size.  Place the cut vegetables into a frying pan that has been coated with a thin layer of olive oil or coconut oil and has been heated to medium high.  Cook the vegetables until brown on the edges, and season with the the herbs and spices of your choice.  Remove the cooked vegetables from the stove, place in a large serving dish, and enjoy.

2. Quinoa is a type of grain that is native to South America and is most often used as a substitute to pasta, though it can also be used to replace stuffing.  In order to get a dish that has a taste similar to that of traditional Thanksgiving stuffing, consider cooking with turkey or vegetable broth in the preparation.  Follow instructions on the side of the box on quinoa in order to achieve optimal results when cooking.

3. Wild rice is a great choice because like eggplant and mushrooms, it is rich in dietary fiber.  For best results when cooking wild rice, consider adding onions, celery and other vegetables. In addition, use a number of different herbs and spices to season your wild rice.  Avoid adding salt to your wild rice.  http://allrecipes.com/Recipe-Tools/Print/Recipe.aspx?recipeID=77977&origin=detail&servings=12&metric=false

4. Grilled squash is rich in many important vitamins and minerals needed for good health.  Grilling squash and other similar vegetables not only imparts a tasty, delicious flavor, but also eliminates the need to add butter, oil or other fats to your cooked dish.  In order to make your grilled squash more closely resemble Thanksgiving stuffing, consider removing the cooked squash from the grill and using a sharp knife to cut it into evenly sized small pieces.   Place in a bowl and serve.

Larger Lunch, Smaller Dinner, Better for Weight Loss

It is common in US culture for people to consume their largest, most calorie rich meal for dinner, once they are done with work.  However, this may not be as good for your health as when you consume more calories at lunch or breakfast lose-weight-healthyand fewer calories at dinner.  A study reported in a paper in the American Journal of Clinical Nutrition found that without changing total calories, eating your larger meal at lunch and a smaller meal at dinner resulted in significantly more weight loss and better control with blood sugar.(1)  It is common for health professionals and  nutritionists to recommend eating a smaller meal in the evening because you will be doing less activity and not burning off the calories. But other research seems to indicate that what matters is how many calories are consumed during the day, not when those calories are consumed.  This new study lends evidence that eating a smaller dinner is helpful.

This research confirms that overweight and obese women who consumed a larger meal at lunch and a smaller meal at dinner lost  12 lbs, 9 oz (5.7 kilograms) as compared to 9 lbs, 7 oz (4.3 kg) for those who consumed a larger dinner.  Overweight and obese women who followed the larger lunch strategy saw greater decreases both in the fasting insulin levels and the HOMA-IR, a measure of insulin resistance.  This strategy of consuming a smaller dinner and a larger lunch appears to be effective both for weight loss and weight management as well as for blood sugar control and prevention of diabetes.  This study did not include patients who have diabetes, though other research indicates that this type of strategy may be effective for diabetics as well.(2)

 

References:

1. Madjd A, Taylor MA, Delavari A, et al. Beneficial effect of high energy intake at lunch rather than dinner on weight loss in healthy obese women in weight-loss program: a randomized clinical trial. AJCN. 2016;104:982-9.

2.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079942/

Fish Oil for Concussion and Brain Injury

The aggressive use of omega 3 fish oil after a traumatic brain injury may be very beneficial.  There are several cases of patients who have suffered severe brain trauma being given high dosages–up to 20,000 mg per day of EPA and DHA–recovered much more quickly and to a larger extent than expected.

Traumatic brain injury (TBI) occurs after “a bump, blow, or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.” In the US there are over 3.5 million TBIs annually with approximately 52,000 deaths. Traumatic brain injury is a clinical challenge and there are not really any effective treatment options. What is needed is an effective treatment strategy that can target neuroprotection, neuroinflammation, and neuroregeneration. Omega-3 fatty acids from fish oil may offer an effective approach. There is a growing body of strong pre-clinical evidence and clinical experience that suggests that larger dosages of fish oil, esp. if taken soon after an injury, can provide the optimal nutritional foundation for recovery and repair of the brain from TBI and concussion. Fish oil is incredibly safe and easy to consume through either capsules, liquid or even through feeding tubes.  There are virtually no side effects, unlike most pharmaceutical interventions, with the exception that there is a slight blood thinning effect.  However, for it to become standard mainstream treatment for a head injury, conventional medicine needs to overcome its inherent bias against nutritional, non-pharmacological therapies–sorry Big Pharma.

We know that the brain and the nerve cells are largely composed of fats and proteins and the types of fats that you eat affect the structural composition of the brain and neuronal cell membranes. Due to increased consumption of omega 6 fats in the modern diet from soybean oil and other commercial seed oils, omega 6 fats have displaced omega 3 fats like DHA from neuronal cell membranes. Omega 6 oils tend to lead to inflammation, whereas omega 3 fats tend to reduce inflammation. In addition, incorporation of mega 6 fats into these neuronal cell membranes reduces “cell permeability and synaptic membrane fluidity”. Therefore, having more omega 3 fats makes the brain function better by improving neuronal transmission of signals.  This new omega protocol for recovery from concussion and brain injury is already being used by  a number of University and professional sports teams.

Lewis MD. Concussions, Traumatic Brain Injury, and the Innovative Use of Omega-3s. Journal of the American College of Nutrition. 2016;35(5): 469-475.

Mediterranean Diet Improves Cognition and Reduces Cognitive Decline, Dementia, and Alzheimer’s Disease

We have an ageing population and degenerative neurological diseases like dementia and Alzheimer’s Disease are an increasing concern. Such conditions are marked by progressive deterioration of memory, learning, orientation, language, comprehension, and judgement.  There are no effective drugs to treat dementia, so prevention is crucial and evidence based preventative strategies are needed.  A recent meta-analysis found that adherence to a Mediterranean eating style improved cognition and reduced the cognitive decline, dementia, and Alzheimer’s Disease that tends to come with age.

 

The Mediterranean diet is generally considered to be an eating style marked by a high intake of olive oil, vegetables, fruits, nuts, legumes, grains; a moderate intake of chicken and fish; with a lower intake of dairy (cheese and yogurt), red meat, processed meats, and sweets; and wine in moderation.  This is the traditional diet eaten by those who lived in southern Italy, Greece, and Spain in the 1960s.

This review looked at 32 papers investigating the link between the Mediterranean diet pattern and cognitive function, cognitive decline, and dementia, with Alzheimer’s disease being the most common form of dementia.  The authors found that higher adherence to the Mediterranean diet was associated with better global cognition and verbal ability and a slower rate of global cognitive decline.  The Mediterranean diet was also associated with significantly reduced confusion, better performance on the MMSE (the Mini-Mental State Examination) and clock-drawing test, and better reaction time on the Corsi Block Test.  The highest adherence to a Mediterranean diet resulted in between a 19 and 69% reduced risk of Alzheimer’s Disease, depending upon the study.

 

The authors discussed the mechanism by which the Mediterranean diet (MD) might lead to these improvements in cognition and reduced rates of cognitive decline and dementia. The MD has been shown to decrease vascular risk factors, thus increasing blood flow to the brain. Second, because the MD contains lots of antioxidants, like vitamin E, vitamin C, folate, and flavonoids, it reduces oxidative stress to the brain that is associated with cognitive decline.  Third, the MD may reduce cognitive decline by reducing inflammation in the brain.  The MD has been shown to lower inflammatory markers such as C-Reactive protein in neuritic plaques and neurofibrillary tangles in the brains of patients with Alzheimer’s Disease. Fourth, the MD has been demonstrated to control blood sugar levels and we know that insulin resistance, which comes with imbalanced blood sugar, is associated with increased risk of dementia and Alzheimer’s Disease. In fact, some have called Alzheimer’s Disease Type III Diabetes.  My recommendation is to follow a low glycemic version of the Mediterranean diet that includes only limited amounts of grains but emphasizes intake of vegetables, nuts, legumes, fruit, olive oil, chicken and fish, eggs, and Greek yogurt.

 

Reference:
1. Petersson SD, Philippou E. Mediterranean diet, cognitive function, and dementia: A systemic review of the evidence. Advances in Nutrition. 2016;7:89-904.