Scientists have developed a new, more effective cervical cancer screening method. The WID-qCIN test detects epigenetic changes in cells, significantly improving early cancer detection. Epigenetic changes in cells refer to alterations that can be influenced by factors such as environment, lifestyle, and aging. In a study of over 28,000 women, published in the June issue of the journal Nature Medicine, this test identified 100 percent of invasive cervical cancers and 93 percent of serious precancerous lesions within a year. Additionally, it predicted 69 percent of cancers and precancerous lesions up to six years later, compared with only 18 percent with current methods. The researchers reported that this advancement could reduce the need for invasive diagnostic procedures by 40 percent, potentially enhancing women’s health and quality of life.

Beetroot Juice Boosts Heart Health in Postmenopausal Women

New research highlights the heart health benefits of beetroot juice for postmenopausal women. Beetroot juice contains high levels of nitrate, which the body converts to nitric oxide. Nitric oxide helps blood vessels expand, making it easier for blood to flow through the circulatory system. The ability of nitric oxide to widen blood vessels is known to be particularly helpful during periods of limited blood flow and oxygen delivery, such as during a heart attack. A study of 24 postmenopausal women, published in the June issue of the journal Frontiers in Nutrition, showed that daily consumption of nitrate-rich beetroot juice significantly improved blood vessel function, reducing heart disease risk. The study included women considered early postmenopausal, or one to six years postmenopause, and late postmenopausal, six or more years postmenopause. Late postmenopausal women saw the same benefits as the early postmenopausal group. This non-pharmaceutical approach offers a promising way for menopausal women to support cardiovascular health naturally.

Study Links Body Fat and Muscle Strength to Alzheimer’s and Parkinson’s Risk

High body fat, especially in the abdomen and arms, increases the risk of developing Alzheimer’s disease and Parkinson’s disease, according to a study published in the July issue of the journal Neurology. Conversely, high muscle strength significantly reduces this risk. The study tracked 412,691 individuals—55 percent of whom were women—with an average age of 56, over nine years. It found that people with high abdominal fat were 13 percent more likely to develop these diseases, while those with high arm fat faced an 18 percent higher risk. High muscle strength, however, decreased the risk by 26 percent. This study highlights the potential to lessen the risk of developing these neurodegenerative diseases by improving body composition. Targeted interventions to reduce belly and arm fat while promoting healthy muscle development may be more effective for protection against these diseases than general weight control, the study’s researchers concluded.

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Troubling Shortfall

The research, led by a team from the University of Michigan Health Frankel Cardiovascular Center, tracked nearly 150,000 people who were seen at hospitals for serious heart conditions (including heart attack and heart failure) between late 2015 and early 2020. The analysis (Journal of the Academy of Nutrition and Dietetics, July) showed that clinicians documented providing dietary counseling in just 23 percent of cases within 90 days of hospitalization. Women, adults ages 65 and older, and people with chronic kidney disease were least likely to receive counseling.

Getting Help

Nutrition counseling is included in cardiac rehabilitation programs, and also can be obtained via a separate kind of care called medical nutrition therapy. “Cardiac rehabilitation programs counsel participants on diet, exercise and behavior modifications, with the aim of improving health outcomes in people with cardiovascular disease,” Dr. Darrow says. “These programs have been shown to boost physical function and reduce the risk of hospitalization and death for older adults with heart failure.” Medicare Part B covers cardiac rehabilitation for enrollees who have had a heart attack in the previous 12 months and those who have stable angina (chest pain caused by blocked heart arteries) or chronic heart failure. People who have undergone cerain heart procedures also are covered—the Medicare website has details (www.cms.gov). “Medical nutrition therapy involves working with a registered dietitian to build an eating plan tailored to your individual health needs,” Dr. Darrow says. The therapy is covered by Medicare Part B for certain individuals (check at the Medicare website). You need a doctor’s referral to utilize the program.

Eating to Support Heart Health

Dr. Darrow provides nutrition guidance to his patients just in case they are not able to attend a cardiac rehabilitation program or get medical nutrition therapy. He recommends people who have cardiovascular disease or have suffered a heart-related event follow an eating plan that is low in sodium and fat, such as the Mediterranean diet (see our chart) or DASH (Dietary Approaches to Stop Hypertension) diet. “Both diets are high in fruits, vegetables, whole grains and healthy fats, and limit the saturated fats that can contribute to elevated blood pressure and cholesterol,” he says. “They also permit enough of what you enjoy that it doesn’t feel like you are depriving yourself at every meal.”

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Defining Superfoods. Superfoods are nutrient-dense and considered beneficial for supporting health. Rich in vitamins, minerals, antioxidants, and other compounds, they support various functions and help protect against diseases.

Nutrient Density and Health Benefits. The main characteristic of superfoods is their high nutrient density. This means they provide a significant amount of nutrients for relatively few calories, making them an excellent choice for those looking to maintain a healthy weight and support health. Some of these key nutrients include:

1. Antioxidants: These compounds help neutralize harmful free radicals in the body, reducing oxidative stress and inflammation. This can help lower the risk of chronic diseases like heart disease and cancer. Berries, such as blueberries and strawberries, are well-known for their high antioxidant content.
2. Dietary Fiber: Essential for digestive health, fiber can help prevent constipation and promote regular bowel movements. It can also aid in controlling blood sugar levels and lowering cholesterol. Foods like oats, beans, and whole grains are excellent sources of fiber.
3. Omega-3 Fatty Acids: Found in foods like fatty fish and walnuts, omega-3s are known for their heart-protective properties. They can help reduce inflammation, reduce blood pressure, and improve overall heart health. Omega-3s are also beneficial for brain health, potentially lowering the risk of cognitive decline and dementia.
4. Vitamins and Minerals: Superfoods are often packed with essential vitamins and minerals. Leafy greens like spinach and kale provide vitamins A, C, and K, as well as calcium and iron, which are vital for bone health, immune function, and overall energy.

Adding Superfoods Into Your Diet. If you’re interested in incorporating superfoods into your daily meals, this can be both simple and enjoyable. Here are some tips to help you get started:

Start Your Day with Berries: Add a handful of blueberries or strawberries to your morning cereal or yogurt for flavor and an antioxidant boost.

Snack on Nuts: A small handful of almonds or walnuts makes a satisfying and nutritious snack, providing healthy fats and protein.

Choose Whole Grains: Opt for brown rice or quinoa to boost fiber intake and help support heart health.

Try Fatty Fish: Aim to include fatty fish, like salmon or sardines in your diet at least twice a week for a good dose of omega-3s.

Conclusion. While superfoods are not a cure-all, they can play a valuable role in a balanced diet. Focusing on nutrient-rich foods can help support overall health, prevent chronic diseases, and enhance quality of life. Remember, it’s important to combine superfoods with other healthy lifestyle choices, such as regular exercise and adequate hydration. Always consult with a healthcare provider or dietitian when making significant dietary changes to ensure they meet your individual health needs.

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In this Q&A, Dana Hunnes, RD, MPH, PhD, Senior Dietitian Supervisor, UCLA Medical Center, provides insights on dietary choices that can help us potentially live longer and also live better.

What does the phrase “food is medicine” mean?

“This phrase means that what we eat has the ability to protect our health, as medicine can,” explains Hunnes. “When we use food to protect our health, we are eating in a way that lowers our risk for chronic conditions. Or if we already have chronic conditions, eating healthfully may help manage them or control them better. If we are fortunate, a heathy diet can possibly reverse them.”

For example, research published in the Journal of Clinical Endocrinology & Metabolism found that study participants who followed an intermittent fasting regimen achieved complete diabetes remission, defined as maintaining an HbA1c level of less than 6.5% for at least a year without diabetes medication.

Why is eating whole foods so beneficial?

“There are many nutrients in whole foods that work synergistically with each other that make the “whole” greater than the sum of its parts,” says Hunnes. “By that I mean, we reap so many more benefits from eating a whole raspberry with all of its fiber and seeds. We gain more antioxidants, anthocyanins, micronutrients, and other anti-inflammatory compounds than we can ever get from eating one isolated nutrient extracted from said raspberry. When we eat ultra-processed foods or isolated nutrients, we are not getting that synergy. We are only getting single nutrients that likely don’t have the same effects.”

A good example of this is taking fish oil supplements for heart health. Numerous studies have shown that fish oil supplementation makes little to no difference in reducing the risk for heart attacks and stroke. But eating fish high in omega-3 fats may reduce risk of heart disease.

Why the  buzz around adhering to a mostly plant-based diet?

“Whole plant foods are filling, lower in calories, nutrient dense, and are associated with lower risk for disease and disability. That doesn’t mean no risk. It just means reduced risk,” she explains. “Plants have naturally occurring compounds that protect them against disease and pests which are also healthful to humans. For example, there are bitter compounds in sulphorphane vegetables (e.g., broccoli, Brussels sprouts, cauliflower) that protect them against pests, but are extremely anti-inflammatory and healthful to humans. Fiber also helps clean out the toxins from our digestive tracts, which is good. We don’t want to keep too much waste in our digestive tracts for long periods of time.”

Though eating these veggies raw provides the most nutrients, not everyone enjoys them raw. Steaming for a minute or two, lightly sautéing or even blanching helps maintain nutrients. Definitely avoid boiling because that method destroys valuable nutrients.

Can foods replace medicines and even cure diseases?

“While I’ve heard of these so-called miracles, they are relatively few and far between,” says Hunnes. “Certain chronic conditions such as diabetes or heart disease can be relieved, reduced, and possibly even reversed (sort-of like cured) by an extremely healthy diet. Other diseases, such as certain types of cancer, far less so, though (again) not impossible. With that said, it’s much easier to decrease the risk of ever developing these diseases, which are food/diet associated, than it is to try to correct/treat them after you have them. Healthy diet is always to our benefit.”

What are some simple ways to incorporate heathy foods daily?

“For easy snacks, keep sliced jicama, carrots, bell peppers, or other favorite veggies with hummus or pureed beans in the fridge,” she suggests. “For sweet treats, make your own trail mix of dried fruits and nuts, or enjoy fresh fruit such as blueberries, raspberries, or other blackberries with walnuts or almonds.”

Another strategy Hunnes suggests is to have a variety of whole and minimally processed foods in your kitchen. Also, be sure to stock canned and frozen healthy foods to ensure that you always have nutrient-rich foods available, regardless of the season. Leave the ultra-processed foods at the store and make rich desserts something you go out for as a special treat. 

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One of the most impressive benefits of hibiscus tea is it’s potential impacts on blood pressure. Studies have shown that drinking hibiscus tea may even be beneficial for people with high blood pressure. It’s like a relaxing sip for the heart!

Additionally, hibiscus tea may be helpful for cholesterol levels. It may help lower LDL (“bad”) cholesterol and raise HDL (“good”) cholesterol levels, supporting heart health and reducing the risk of heart disease.

Hibiscus tea also has anti-inflammatory and antimicrobial properties, which can boost your immune system and help fight off infections. Plus, it shows promise in helping to regulate blood sugars, which is good news for those who are managing diabetes.

In short, hibiscus tea is a tasty, health-supporting beverage. So, the next time you’re looking for a new drink, brew a cup of hibiscus tea and reap the health and taste benefits. 

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What are Phytonutrients? Phytonutrients are bioactive compounds produced by plants as part of their defense mechanisms against environmental challenges such as pests, UV radiation, and diseases. Unlike essential nutrients required for basic bodily functions, phytonutrients are not necessary for survival but can significantly enhance health and reduce the risk of chronic diseases.

There are thousands of different phytonutrients, each with unique properties and health benefits. These compounds can be categorized into several classes, including carotenoids, flavonoids, phenolic acids, and glucosinolates, among others.

Major Classes of Phytonutrients.

Carotenoids: Carotenoids are pigments found in brightly colored fruits and vegetables, such as carrots, sweet potatoes, spinach, and tomatoes. They are responsible for the red, orange, and yellow hues of these foods. Some well-known carotenoids include beta-carotene, lycopene, and lutein.

Beta-Carotene is a precursor to vitamin A, essential for vision, immune function, and skin health.

Lycopene is linked to a reduced risk of prostate cancer and cardiovascular disease.

Lutein and Zeaxanthin are important for eye health, reducing the risk of age-related macular degeneration and cataracts.Flavonoids: Flavonoids are a diverse group of phytonutrients found in a wide variety of plant-based foods, including berries, apples, onions, tea, and red wine. There are several subtypes of flavonoids, such as flavonols, flavones, flavanones, and anthocyanins.

Quercetin, a flavonol, has anti-inflammatory and antioxidant properties, helping to reduce the risk of chronic diseases like heart disease and cancer.

Catechins, found in green tea, are associated with improved heart health and weight management.

Phenolic Acids: Phenolic acids, such as caffeic acid and ferulic acid, are found in coffee, whole grains, fruits, and vegetables. These compounds have strong antioxidant properties, helping to neutralize harmful free radicals and reduce inflammation.

Caffeic Acid is linked to anti-inflammatory and antidiabetic effects.

Ferulic Acid has been shown to protect against UV radiation and reduce the risk of chronic diseases.

Glucosinolates: Glucosinolates are sulfur-containing compounds found in cruciferous vegetables like broccoli, Brussels sprouts, and cabbage. When these vegetables are chopped or chewed, glucosinolates are broken down into biologically active compounds such as isothiocyanates and indoles.

Sulforaphane, an isothiocyanate, has anticancer properties and may enhance detoxification processes in the body.

How They Work. Phytonutrients exert their health benefits through several mechanisms:

1. Antioxidant Activity: Many phytonutrients have strong antioxidant properties, which help neutralize free radicals—unstable molecules that can damage cells and lead to chronic diseases. By reducing oxidative stress, phytonutrients protect against conditions such as cancer, cardiovascular disease, and neurodegenerative disorders.

2. Anti-Inflammatory Effects: Chronic inflammation is a common underlying factor in many diseases. Phytonutrients like flavonoids and phenolic acids can modulate inflammatory pathways, reducing inflammation and the risk of associated diseases.

3. Modulation of Detoxification Enzymes: Some phytonutrients enhance the activity of detoxification enzymes in the liver, helping to eliminate carcinogens and other harmful substances from the body. For example, sulforaphane in cruciferous vegetables boosts the production of phase II detoxification enzymes.

4. Hormonal Balance: Certain phytonutrients can influence hormone metabolism and activity. Indole-3-carbinol from cruciferous vegetables, for example, helps balance estrogen levels and reduce the risk of hormone-related cancers.

How to Get Phytonutrients. Given their significant health benefits, it is important to include a variety of phytonutrient-rich foods. Here are some practical tips:

Eat a Rainbow: Consume a wide range of colorful fruits and vegetables to ensure you get a variety of phytonutrients.

Choose Whole Foods: Whole grains, nuts, seeds, and legumes are excellent sources of phytonutrients.

Keep it Fresh (as Possible): Fresh, raw, or lightly cooked foods tend to retain more phytonutrients compared to heavily processed ones.

Experiment with Spices and Herbs: Many spices and herbs, such as turmeric, ginger, and garlic, are rich in phytonutrients and can enhance the flavor and nutritional value of meals.

The Bottom Line. Phytonutrients are vital, bioactive compounds found in plants that offer a multitude of health benefits. By incorporating a diverse array of phytonutrient-rich foods into your diet, you can support overall health, reduce the risk of chronic diseases, and promote longevity.

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“I can’t talk to my patients about their cardiovascular health without addressing their mental health,” says Dr. Erin Michos, director of women’s cardiovascular health research at Johns Hopkins School of Medicine, speaking at last year’s annual meeting of the Academy of Nutrition and Dietetics. She noted there’s been an increase over the last 10 years of people with mental health disorders—especially anxiety disorder and major depression—being admitted to the hospital after having a heart attack.

Effects of Stress and Sleep. Michos says both negative and positive psychological factors influence cardiovascular health. Take stress for example. “Not all stress is bad. Stress is what helps us meet deadlines, but chronic stress can change some processes in the body.” She says chronic stress—as well as anxiety, anger, and depression—can directly trigger the release of stress hormones, elevate heart rate and blood pressure, increase inflammation, stiffen the arteries, increase the risk of blood clots, and constrict blood vessels on the heart’s surface.

A 2019 study found that people who slept less than six hours or more than nine hours per night were more likely to have a heart attack. Michos says this may be because short or long sleepers are more likely to be struggling with depression, other mental health concerns, or a chronic physical illness. In other words, is it the sleep pattern affecting the heart, or is a physical or mental illness affecting both sleep and the heart? For example, a 2021 study found that women veterans with PTSD had a 44 percent increased risk of cardiovascular death, possibly because trauma to the brain leads to both mental disorders and cardiovascular disease.

Chronic stress and poor mental health can also contribute to heart disease indirectly, by affecting how we take care of ourselves. For example, some people may try to cope with stress, anxiety, or depressed mood by smoking, overusing alcohol, or stress eating. And when someone’s in distress, they’re less likely to take medications as prescribed or seek preventive healthcare.

The Power of Resilience. On the other hand, positive psychological health—happiness, emotional vitality, optimism, sense of purpose, gratitude, mindfulness—is linked to healthier blood pressure and blood sugar levels, but also to behaviors that support health, including increased physical activity, heart-healthy eating, and other essential forms of self-care.

Being optimistic and having a purpose in life are both linked to better survival from cardiovascular disease, and so is having positive social connections. A 2023 UK study that followed 18,509 people with diabetes for more than 10 years found that loneliness was associated with a 20 percent increased risk of cardiovascular disease. That makes it a bigger risk factor than depression and some “traditional” risk factors, such as high blood pressure and blood sugar, smoking, low physical activity and poor diet.

Sleep, physical activity, and a nutritious diet help build personal resilience against stress, as can learning healthy ways to cope, bonding with family and friends, practicing mindfulness (perhaps through mindfulness meditation), engaging in genuine laughter, and reframing setbacks as opportunities. Cultivating gratitude (perhaps with a gratitude journal), a sense of optimism, and self-compassion are also key. “I think we’re harder on ourselves than others are,” Michos says.

The Role of Diet and Exercise. The American Heart Association (AHA) acknowledges the links between stress, mental health, and the heart, and its recommendations for a heart-healthy diet—vegetables, fruits, and whole grains, pulses (beans and lentils), nuts, fish and seafood, unsweetened dairy products, and healthy fats from avocados, olive oil, and other liquid oils—can benefit mental health as well.

“We know that diet quality at every life stage does affect health and well-being,” says Kristina Petersen, PhD, associate professor of nutritional sciences at Penn State University, who co-presented with Michos. A poor diet along with impaired sleep and reduced physical activity are associated with major depressive disorder in what may be a chicken-or-the-egg scenario—which comes first?

Petersen says a healthy eating pattern is associated with lower odds of depression, possibly because the vitamins, minerals, phytochemicals, fiber and healthy fats have positive effects on the gut microbiota while helping to reduce levels of stress hormones, inflammation, and oxidative stress in the body. All of this can have positive effects on the brain and the heart. On the exercise front, she says at least 150 minutes of moderate intensity physical activity per week can help buffer against stress, anxiety, and depression, while directly benefiting heart health.

The Bottom Line. The clear connections between mental and cardiovascular health are a reminder that we should tend to both mind and our body. Fortunately, what’s good for one may well be good for the other.

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The Facts. Carob (Ceratonia siliqua) is part of the legume family, along with beans, peas, and lentils. Its fruit is a dark brown pod that resembles a bean or pea pod. The hard-shelled pod contains a sugary pulp and seeds which contain fat and minerals. The seeds produce a gum used in cosmetics and pharmaceuticals and many processed foods like baked goods and ice cream as a stabilizer and for texture. The pulp is dried, roasted, and ground to make carob powder used as a cocoa, cacao, and chocolate substitute in baked goods and beverages. A one and one-half tablespoon serving of carab has 21% DV (DV=Daily Value, based on 2,000 calories/day) of dietary fiber, which supports heart health and digestive health. Carob also contains essential minerals, including calcium and potassium, and is rich in antioxidant polyphenols. 

The Findings. Rich in polyphenols, flavonoids, carbohydrates, minerals, and proteins, carob leaves, bark, and seeds have a long medicinal history of treating various diseases, such as diarrhea, diabetes, and hypertension, due to its antioxidant, antidiarrheal, antibacterial, antiulcer, and anti-inflammatory activities (Plants, 2023). Research shows the potential of carob extract, rich in pectin, gums, and polyphenols, to support a balanced gut flora, improve glucose metabolism, and help in the management and prevention of chronic diseases like diabetes and obesity. Carob also has a small environmental footprint, allowing larger cultivation during long periods of warm temperatures and drought, making it suited to a sustainable Mediterranean dietary pattern (Foods, 2022).

The Finer Points. The drying process of carob pods completes in August, when they begin to fall from the tree. They are sold as pods, both raw and roasted, as powder (also called carob flour), chips, syrup (also called carob molasses), and extract. Carob can be a one-to-one substitute for cocoa and chocolate chips in recipes as a healthier alternative. Try it in baked goods, cookies, granola bars, trail mixes, overnight oats, and yogurt—anywhere you use cocoa powder or chocolate chips. It has a unique flavor, so a half-and-half mix of cocoa and carob might be a good way to begin. 

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Dementia Pathology Doesn’t Always Mean Dementia

As we age, an abnormal protein called amyloid-beta (A-beta) builds up in the brain. Some research has linked this buildup with dementia—the theory is that A-beta deposits (referred to as plaques) disrupt communication between brain cells and eventually destroy these cells. However, not everyone with A-beta deposits develops dementia. The RUMC study (JAMA Neurology, March) set out to find out why these individuals maintain good neurological function.

The researchers analyzed data from 586 deceased individuals with up to 24 years of follow-up data on lifestyle factors and annual cognitive testing (including testing close to when they died, at an average age of 91), and autopsy data. A healthy lifestyle score was developed based on self-reported factors, including diet quality, weekly physical activity levels, late-life cognitive activity, limited alcohol consumption, and nonsmoking. The lifestyle score ranged from 0 to 5, with higher scores reflecting a healthier lifestyle.

Brain autopsies carried out on the participants looked for characteristic signs of dementia: A-beta plaques, along with tangles of tau (another abnormal protein associated with dementia) and changes in blood vessels that might suggest reduced circulation in the brain due to cardiovascular issues, such as narrowed arteries and strokes. “The analysis showed that study participants with higher healthy lifestyle scores were more likely to have maintained their cognition at the end of life even if their brain autopsies revealed the presence of A-beta and tau and blood flow in their brains was impaired,” Dr. Bloom says.

Protective Buffer Zone

The data suggested that 88 percent of a person’s overall cognition score is associated with lifestyle, with 12 percent affected by the presence of A-beta—but there are some limitations to keep in mind. “For example, the lifestyle factors included were self-reported, meaning they may not be entirely accurate,” says Dr. Bloom. “Moreover, a person’s cognitive abilities may affect their adherence to lifestyle factors like physical activity—put simply, people who maintain their cognition may be more likely to exercise, so reverse causation could be introducing a degree of bias in the data.” Also, most of the study participants were white, meaning that the results may not be generalizable to people of other races and ethnicities. “That said, the findings support the theory that lifestyle factors may provide a degree of cognitive reserve that makes the brain flexible enough to continue functioning well even if it is experiencing changes that are a hallmark of dementia,” Dr. Bloom says.

Habits to Follow

The factors researchers involved in the study used to calculate the participants’ healthy living scores included:

• MIND diet adherence To assess the study participants’ overall diet quality, the researchers calculated their MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet score. The MIND diet combines the Mediterranean diet with the DASH (Dietary Approaches to Stop Hypertension) diet. Studies have suggested that it can lower the risk of Alzheimer’s disease by up to 50 percent.

While there are no set rules for following the MIND diet, you’re encouraged to eat more of the foods the diet prioritizes: vegetables (particularly leafy greens), berries, whole grains, nuts, beans, poultry, fatty fish (salmon, mackerel, tuna, trout), and olive oil. The diet also recommends avoiding certain foods (butter/margarine, cheese, red meat, fried foods, and pastries/sweets).

• Engaging in cognitively stimulating activities In the study, these were defined as reading, visiting museums, playing games like cards and checkers, and doing crosswords or puzzles. “Other studies have suggested that learning a second language or learning how to play an instrument in older age also provide cognitive stimulation,” Dr. Bloom adds.

• Exercise The study participants reported the amount of time they spend engaged in a range of moderate to vigorous activities including walking for exercise, gardening, bicycle riding, and swimming. “Federal exercise guidelines for older adults recommend at least 150 minutes of physical activity per week, but if you’re not used to exercising or have any chronic health issues, discuss with your doctor how best to start a regular workout regimen,” Dr. Bloom advises.

• Limiting alcohol intake Numerous studies have suggested that alcohol consumption may benefit cardiovascular and brain health, and alcohol is permitted by the MIND diet as long as you limit your intake to no more than one drink per day. But keep in mind that many other studies have suggested that no amount of alcohol is safe—plus, alcohol interacts with many drugs and raises the risk of falls. “If you’re a teetotaler, don’t start imbibing to follow the MIND diet more closely,” Dr. Bloom says. “If you habitually consume more than one alcoholic drink per day, it is advisable to cut back, particularly if you take medications to manage chronic health conditions.”

• Not smoking Smoking raises the risk for many cancers and is harmful to cardiovascular health. If you would like to quit but are finding this difficult, ask your doctor about smoking cessation aids and counseling.

Healthy Lifestyle, Healthy Brain

The study cannot prove cause and effect—more investigation is needed to confirm the findings. But even so, the data underline how much lifestyle choices may impact our cognitive health as we age. “The take-home is that even if many older adults have the brain pathology characteristic of dementia, it doesn’t necessarily mean they will develop the disease,” Dr. Bloom says. “Just as healthy choices can help protect your heart health, they also may confer protection against dementia.”

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Primary and Secondary Prevention

The study we reference (BMJ Medicine, May 21) included 415,737 people, ages 40 to 69, who were surveyed between 2006 and 2010 to gather health information that included their usual dietary intake of fatty and non-fatty fish, and fish oil supplements. Nearly one-third of the participants said that they regularly took fish oil supplements.

The researchers set out to examine the association between fish oil supplements and the primary prevention of a range of cardiovascular disease outcomes over an average 12-year follow-up. The disease outcomes in question included the abnormal heart rhythm atrial fibrillation, major adverse cardiovascular events (such as heart attack and stroke), and all-cause death in people who either had no known cardiovascular disease or were at high risk of cardiovascular disease.

“Primary prevention essentially is defined as preventing a disease or disease-related event from ever occurring,” explains Mount Sinai cardiologist Bruce J. Darrow, MD, PhD. “The researchers also assessed the modifying effects of fish oil supplements on atrial fibrillation and other outcomes in people with known cardiovascular disease for the purpose of secondary prevention—that is, preventing the recurrence of disease or disease-related event in people who already have a specific health condition.”

Role Playing

The analysis indicated that regular use of fish oil supplements played different roles in cardiovascular health, disease progression, and death. “For people with no known cardiovascular disease at the start of the monitoring period, regular use of fish oil supplements was associated with a 13 percent greater risk of developing atrial fibrillation and a 5 percent greater risk of suffering a stroke,” Dr. Darrow notes. “Among people who had atrial fibrillation at the start of the trial, regular use of fish oil supplements was associated with a 15 percent lower risk of heart attack during follow-up. People with heart failure who took fish oil supplements had a 9 percent lower risk of dying during follow-up.”

No Strong Proof

Dr. Darrow points out that this was an observational study. “An observational study is a type of study in which researchers are not attempting to influence the results through some type of intervention, such as a drug,” he explains. “Observational studies cannot prove cause and effect. With this specific study, it’s hard to draw any conclusions about who was taking supplements for what period of time across the 12-year follow-up.” He adds that there are other important things we don’t know about the study participants. “For example, those who reported being healthy may have had heart disease that had not yet been diagnosed. We also don’t have any information on the formulation or dosage of the supplements taken by the participants— previous studies have shown that very high doses of fish oil raise the risk of atrial fibrillation.”

Better Evidence of Benefit

The 2018 VITAL study remains the largest randomized controlled trial to look at fish oil supplementation in people with no known cardiovascular disease. The results suggested that the supplements reduced the risk of heart attack and all cardiovascular disease-related events by 28 percent and 17 percent, respectively. The effect of fish oil on atrial fibrillation was not studied, and there was no increase in stroke.

“VITAL was a randomized, controlled trial, and because the formulation and dosage of supplements was carefully monitored in the study, the results are stronger proof of the possible benefits of supplementation,” Dr. Darrow says. “Further studies would be useful to determine whether any outside influences modify the effects of fish oil supplements and clarify how the supplements might influence the development and prognosis of cardiovascular disease-related events.”

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