Fresh-Pressed Olive Oil Club

The Olive Oil Hunter News #135

Salade Niçoise Recipe, For Your Best Health: Lowering the Risk for Dementia with the Mediterranean Diet

The benefits of extra virgin olive oil as part of the acclaimed Mediterranean diet never cease to amaze me. Food lovers including members of the Fresh-Pressed Olive Oil Club appreciate the depth of flavor of EVOO and would love it even without all the health benefits. But it’s the very presence of powerful polyphenols that both give EVOO its taste and convey its benefits, along with its good-for-you unsaturated fats. To be able to share a new study on how the Mediterranean diet can help stave off dementia is very exciting for me. I know you’ll be fascinated by the findings. I’m also sharing a quintessential Mediterranean recipe—salade Niçoise, straight from Nice on the French Riviera, part of that country’s Mediterranean Sea shoreline. Enjoy!

Salade Niçoise

  • Salade Nicoise Salade Niçoise

    Few dishes symbolize the south of France like salade Niçoise. Although you may not think you like anchovies or capers, they do add to the layers of flavor without being obvious, so try them. You can also build on the basic ingredients to personalize the salad—sliced radishes, red onion, pimentos, and artichoke hearts are just a few of the popular additions. Need a picnic option? Turn this into the classic sandwich of Nice, the pan bagnat, by simply packing all the ingredients into a tranche of a baguette or a crusty whole wheat roll. 


    For the vinaigrette:

    • 1 tablespoons honey
    • 2  tablespoons balsamic vinegar of Modena 
    • 1/2 tablespoon Dijon mustard
    • 1/4 teaspoon fine sea salt
    • 1/4 teaspoon finely ground black pepper 
    • 1 medium garlic clove, minced
    • 6  tablespoons extra virgin olive oil

    For the salad:

    • 1 tablespoon fine salt
    • 1 pound red potatoes
    • 1 pound haricots verts or string beans, trimmed
    • 4 cups greens, any varieties 
    • 12 ounces freshly grilled tuna or 2 large cans tuna, drained
    • 2 cups cherry tomatoes, halved
    • 4 hard-boiled eggs, halved
    • 1 cup Niçoise or other small black olives, pitted 
    • 8 anchovy fillets, drained
    • 2 tablespoons capers, drained 
    • Fleur de sel or grey coarse sea salt, to taste
    • Freshly ground black pepper, to taste


    Step 1

    Make the vinaigrette: in a medium mixing bowl, whisk together the honey, balsamic, mustard, salt, pepper, and garlic. Add the oil and whisk continuously until the dressing is emulsified. Set aside.

    Step 2

    Bring a large pot of water to a boil and add the fine salt. Add the potatoes and boil for 15 minutes, then add the beans and boil everything for another 3 minutes. Strain the vegetables and wait until cool enough to handle. If the potatoes are small, cut them in half; if large, into quarters.

    Step 3

    To assemble the salad, choose either one large platter or individual plates. Start with the lettuce, then arrange, in sections, the potatoes, green beans, tuna, tomatoes, eggs, olives, and anchovies, plus any other veggies you choose to add. Sprinkle on the capers and dress everything with the vinaigrette. Finish with the fleur de sel or coarse grey salt and pepper.

    Yields 4 servings

Best Health: The Mediterranean Diet: Reversing Metabolic Syndrome After Heart Disease

For Your Best Health

Lowering the Risk for Dementia with the Mediterranean Diet  

The Study: “Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study,” BMC Medicine, March 2023.

The Findings: According to researchers from Newcastle University in the UK, people who ate a Mediterranean-like diet had up to a 23% lower risk for dementia than those who did not. This research is one of the biggest studies of its kind, as previous studies have typically been limited to small sample sizes and low numbers of dementia cases.

The Report from Newcastle University: Scientists analyzed data from 60,298 people from the UK Biobank, a large cohort including individuals from across the UK, who had completed a dietary assessment. The authors scored them based on how closely their diet matched the key features of a Mediterranean one. The participants were followed for almost a decade, during which time there were 882 cases of dementia.

The authors considered each individual’s genetic risk for dementia by estimating what is known as their polygenic risk—a measure of all the different genes that are related to the risk of dementia. Oliver Shannon, PhD, Lecturer in Human Nutrition and Ageing, Newcastle University, led the study with Professor Emma Stevenson and joint senior author Professor David Llewellyn. The research also involved experts from the universities of Edinburgh, UEA and Exeter and was part of the Medical Research Council-funded NuBrain consortium.

“Dementia impacts the lives of millions of individuals throughout the world, and there are currently limited options for treating this condition. Finding ways to reduce our risk of developing dementia is, therefore, a major priority for researchers and clinicians. Our study suggests that eating a more Mediterranean-like diet could be one strategy to help individuals lower their risk of dementia,” Dr. Shannon says.

The University of Exeter’s Janice Ranson, PhD, joint lead author on the paper, says, “The findings from this large population-based study underscore the long-term brain health benefits of consuming a Mediterranean diet, which is rich in fruits, vegetables, whole grains, and healthy fats. The protective effect of this diet against dementia was evident regardless of a person’s genetic risk, and so this is likely to be a beneficial lifestyle choice for people looking to make healthy dietary choices and reduce their risk of dementia. Future dementia prevention efforts could go beyond generic healthy diet advice and focus on supporting people to increase consumption of specific foods and nutrients that are essential for brain health.”

The authors caution that their analysis is limited to individuals who self-reported their ethnic background as white, British, or Irish, as genetic data was only available based on European ancestry, and that further research is needed in a range of populations to determine the potential benefit. They conclude that, based on their data, a Mediterranean diet that has a high intake of healthy plant-based foods may be an important intervention to incorporate into future strategies to reduce dementia risk.

The Bottom Line: According to the study abstract, “higher adherence to a MedDiet was associated with lower dementia risk, independent of genetic risk, underlining the importance of diet in dementia prevention interventions.”

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The Olive Oil Hunter News #130

Stone Fruit and Berry Buckle Recipe, Spotlight on Blueberries, Flavanols and Memory, Freezing Summer’s Bounty and Walking for Your Brain

With farmers’ markets brimming with all kinds of berries and ripe stone fruit like peaches, plums, and nectarines, there’s no better time to bake a buckle—a one-layer cake named for the dimpled look as the cake rises over chunks of fruit and a tempting crumble topping. This issue of the newsletter also has a boost-your-memory theme, with two important studies—one looks at the cognitive risks of flavanol deficiency and the other, at how walking boosts brain connectivity and thereby memory. 

Stone Fruit and Berry Buckle

  • Stone Fruit and Berry Buckle Recipe Stone Fruit and Berry Buckle

    This recipe is sized to feed a crowd—any leftovers make a terrific breakfast the next day. Choose fruit based on availability—it’s as delicious with just one variety as it is with four or more! Right out of the oven, the buckle is exceptional when topped with olive oil ice cream, a simple frozen treat you can make at home.


    For the crumble topping:

    • 4 ounces unsalted butter, cubed and chilled
    • 1 cup sugar
    • 2/3 cup all-purpose flour
    • 1/2 teaspoon ground cinnamon 

    For the cake:

    • 1/2 cup extra virgin olive oil, plus more for the baking dish
    • 8 ounces unsalted butter at room temperature 
    • 2 cups sugar 
    • 8 large eggs
    • 3 cups all-purpose flour 
    • 1 teaspoon fine salt
    • 1-1/2 teaspoons baking powder
    • 6 cups assorted berries and stone fruit chunks (skin on) 
    • Optional toppings: fresh blueberries, confectioners’ sugar for dusting, lightly whipped cream, or ice cream


    Step 1

    Preheat your oven to 350°F. Lightly coat a 13-inch by 9-inch baking dish with olive oil; set aside. 

    Step 2

    Make the topping: Use your hands or a pastry blender to turn the butter, sugar, flour, and cinnamon into small bits, ranging from the size of peas to the size of beans. Set aside.

    Step 3

    Make the batter: In a large bowl, cream butter and sugar with an electric mixer until fluffy. With the machine running on low, slowly pour in the olive oil and then add the eggs, one at a time, beating after each addition until combined. In a separate bowl, whisk together flour, salt, and baking powder. With your mixer on a low speed, gradually add flour mixture to the wet batter until incorporated.

    Step 4

    Transfer the batter to the baking dish and use a large offset spatula to smooth the surface. Arrange the fruit in a fun pattern over the top and then sprinkle on the crumble, being careful to get it into the corners of the dish so that every bite includes it. 

    Step 5

    Bake until the top of the cake is browns lightly and the tip of a sharp knife inserted in the center comes out clean, about an hour. Serve while still warm.

    Yields 12 servings

Healthy Ingredient Spotlight: Bountiful Blueberries

Healthy Ingredient Spotlight

Bountiful Blueberries

Blueberries are more than delicious—they pack amazing health benefits. Here are four great reasons why, according to Cleveland Clinic dietitian Julia Zumpano, RD, LD.

Blueberries pack an antioxidant wallop. Along with having vitamins C and K and the mineral manganese, they’re rich in anthocyanins, which give the berries their blue-purple color and protect our cells from damaging molecules called free radicals. To get the most antioxidants, enjoy some blueberries raw, and always choose organic when available.  

Blueberries’ soluble fiber helps manage blood cholesterol by sweeping cholesterol-laden bile out of the body, which, in turn, can lower the risk for heart disease. 

Blueberries help decrease blood sugar levels, thanks to the combination of their fiber and a lower amount of natural sugar than other fruits, according to some studies. 

Blueberries may also help with blood pressure, especially in people with metabolic syndrome. Eating them contributes to the body’s production of nitric oxide, which helps relax blood vessels.

Quick Kitchen Nugget: Freezing Fruits and Vegetables

Quick Kitchen Nugget

Freezing Fruits and Vegetables

Want to save some of summer’s bounty for the winter? Freeze pieces individually by spreading them in a single layer on a rimmed sheet pan. When frozen solid, transfer to airtight freezer-safe containers or bags, filling them up to minimize the amount of trapped air and avoid “snow” forming on the pieces. 

For Your Best Health: Flavanols and Memory

For Your Best Health

Flavanols and Memory

A large-scale study led by researchers at Columbia and Brigham and Women’s Hospital/Harvard is the first to establish that a diet deficient in flavanols, a specific type of phytonutrient within the flavonoid group, is linked to age-related memory loss.

The study found that flavanol intake among older adults tracks with scores on tests designed to detect memory loss due to normal aging and that replenishing these bioactive dietary components in mildly flavanol-deficient adults over age 60 improves their performance on these tests.

“The improvement among study participants with low-flavanol diets was substantial and raises the possibility of using flavanol-rich diets or supplements to improve cognitive function in older adults,” says Adam Brickman, PhD, professor of neuropsychology at Columbia University Vagelos College of Physicians and Surgeons and coleader of the study. The finding also supports the emerging idea that the aging brain requires specific nutrients for optimal health, just as a baby’s brain requires specific nutrients for proper development.

The current study builds on over 15 years of research done in the lab of the study’s senior author, Scott Small, MD, the Boris and Rose Katz Professor of Neurology at Vagelos. That work linked The current study builds on over 15 years of research done in the lab of the study’s senior author, Scott Small, MD, the Boris and Rose Katz Professor of Neurology at Vagelos. That work linked age-related memory loss to changes in the dentate gyrus, a specific area in the brain’s hippocampus (a region vital for forming new memories), and showed that flavanols improved function in this part of the brain.

The Columbia team collaborated with researchers at Brigham and Women’s Hospital studying the effects of flavanols and multivitamins in COSMOS (COcoa Supplements and Multivitamin Outcomes Study). The current study, COSMOS-Web, was designed to test the impact of flavanols in a much larger group and explore the link between flavanol deficiency and cognitive aging in the hippocampus.

How the study was done

More than 3,500 healthy older adults were randomly assigned to receive a daily flavanol supplement or placebo for three years. The active supplement contained 500 mg of flavanols, including 80 mg of epicatechins, an amount that adults are advised to get from food.

At the beginning of the study, all participants completed a survey that assessed the quality of their diet, including foods known to be high in flavanols. Participants then performed a series of web-based activities in their own homes, designed and validated by Dr. Brickman, to assess the types of short-term memory governed by the hippocampus. The tests were repeated after one year, two years, and three years. 

More than a third of the participants also supplied urine samples that allowed researchers to measure a biomarker for dietary flavanol, a test developed by the study’s coauthors at Reading University in the UK, before and during the study. The biomarker gave the researchers a more precise way to determine whether flavanol levels corresponded to performance on the cognitive tests and ensure that participants were sticking to their assigned regimen (compliance was high throughout the study). Flavanol levels varied moderately, though no participants were severely flavanol-deficient.

At the end of the first year of taking the flavanol supplement, participants who reported consuming a poorer diet and had lower baseline levels of flavanols saw their memory scores increase by an average of 10.5% compared to placebo and 16% compared to their memory at baseline. Annual cognitive testing showed that the improvement observed at one year was sustained for at least two more years.

The results strongly suggest that flavanol deficiency is a driver of age-related memory loss, the researchers say, because flavanol consumption correlated with higher memory scores and flavanol supplements improved memory in flavanol-deficient adults.

Next steps

“We cannot yet definitively conclude that low dietary intake of flavanols alone causes poor memory performance, because we did not conduct the opposite experiment: depleting flavanol in people who are not deficient,” Dr. Small says, adding that such an experiment might be considered unethical.

The next step needed to confirm flavanols’ effect on the brain, Dr. Small says, is a clinical trial to restore flavanol levels in adults with severe flavanol deficiency. “Age-related memory decline is thought to occur sooner or later in nearly everyone, though there is a great amount of variability,” he explains. “If some of this variance is partly due to differences in dietary consumption of flavanols, then we would see an even more dramatic improvement in memory in people who replenish dietary flavanols when they’re in their 40s and 50s.”

Flavanols are found in many healthful foods that you can add to your diet for a variety of health benefits: berries, peaches, grapes, onions, scallions, tomatoes, lettuce, broccoli, kale, and tea.

Fitness Flash: The Brain Benefits of Walking

Fitness Flash

The Brain Benefits of Walking

Researchers have long known that moderate exercise has a beneficial impact on the body’s response to inflammation, but what’s been less understood is why. New research done on a mouse model at York University in Toronto, Canada, suggests that the answers may lie within the body’s macrophages, white blood cells responsible for killing off infections, healing injury, and otherwise acting as your internal first responders.

“Much like you train your muscles through exercise, we showed that exercise of moderate intensity ended up training the precursors of those macrophages in the bone marrow,” says Ali Abdul-Sater, PhD, associate professor in the University’s School of Kinesiology and Health Science and York Research Chair. “The way that exercise is doing this is by changing the way those cells breathe—essentially, how they use oxygen to generate energy and then changing the way they access their DNA.”

While many studies have looked at temporary boosts to the immune system immediately after exercise, this study, published in the American Journal of Physiology-Cell Physiology, found these changes occurred even a week later, suggesting that they are long term. 

“Inflammation is amazing—it’s a very important part of our normal immune response,” says Dr. Abdul-Sater. Inflammation is the body’s response to infection and other stressors, and some level of inflammation is necessary and desirable. “What we’re concerned about is excessive inflammation,” he explains. “Heart disease, diabetes, many cancers, and autoimmune diseases all essentially begin because there was an inappropriate inflammatory response.”

The study found that, for active mice, it was around the six-to-eight-week mark into the exercise regimen when changes really became apparent. “There’s a lot of rewiring that’s taking place in the circuitry of how the cells breathe, how the cells metabolize glucose, how the cells then access DNA. So all that just takes time.”

Dr. Abdul-Sater says that because the inflammatory response is a very ancient one, this aspect of the immune system is generally very similar across mammals, and he expects the research will translate well to people. In the next phase, the team will collect immune cells from human volunteers who will do exercises of various intensities to see which workout routines are most beneficial to balance the inflammatory response. 

“The thing with humans is there’s no intervention that will work on everyone. We know that, but what this study suggests is that moderate and persistent exercise not only improves metabolic health, but also will improve immune health in the long run.”

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Olive oil is shown to improve brain health and memory in individuals with mild cognitive impairment

Adapted from an article by Matt Crouch, Auburn University (, March 6, 2023

Extra virgin olive oil may have positive effects on individuals with mild cognitive impairment, according to a recently completed study published in the journal Nutrients. The study’s findings suggest that compounds found in olive oil positively affect brain health and help improve the blood-brain barrier.

In the study, 25 adult participants experiencing mild cognitive impairment consumed 30 ml (about three tablespoons) of olive oil per day for six months. Thirteen of the participants consumed extra virgin olive oil (EVOO) and 12 consumed refined olive oil (ROO), as a control group. EVOO is rich in phenols, while ROO has been purified of phenols.

Study participants took several tests before and after consuming olive oil, including MRI scans, cognitive tests, and blood analysis to measure biomarkers related to Alzheimer’s disease.

This study evaluated the blood-brain barrier and its permeability—the degree to which it protects the brain. The blood-brain barrier, a network of blood vessels and tissue made up of closely spaced cells, plays a vital role in maintaining a healthy brain by protecting the brain from exposure to blood-related neurotoxins and in the clearance of brain waste products.

The study also measured levels of beta-amyloid and tau, two proteins associated with Alzheimer’s disease. In people with Alzheimer’s disease, levels of beta-amyloid and tau are increased.

The benefits of olive oil consumption were more pronounced in the EVOO group, but participants in the ROO group experienced improvements as well: Both EVOO and ROO improved cognitive function, as determined by the improved clinical dementia rating and other behavioral scores. Additionally, “our findings showed that EVOO and ROO altered two major biomarkers related to Alzheimer’s disease,” said Kaddoumi. “These alterations collectively could have played a role in improving the blood-brain barrier and improving function and memory.”

This study in individuals with mild cognitive impairment is the first to evaluate what happens to the human brain as a result of consuming olive oil.

“These results are exciting because they support the health benefits of olive oil against Alzheimer’s disease,” said Kaddoumi. “Based on the findings of this study and previous preclinical studies… we can conclude that adding olive oil to our diet could maintain a healthy brain and improve memory function.”

Reference: Kaddoumi A, Denney TS, Deshpande G et al. Extra-virgin olive oil enhances the blood-brain barrier function in mild cognitive impairment: a randomized controlled trial. Nutrients. 2023;14(23):5102.

The Olive Oil Hunter News #120

Pasta with Garlic and Olive Oil Recipe, Protecting Brain Health Through Diet: More Benefits of the Olive Oil Lifestyle

More and more research is linking certain diets to better brain health and the possibility of warding off various types of dementia, including Alzheimer’s disease. It’s encouraging to read about variations on the Mediterranean diet, all of which deliver the benefits of olive oil. The study I’m sharing owes a huge debt to its participants who were willing to not only keep food diaries, but also allow scientists to examine their brains after they passed, thereby enlightening the rest of us. One clear message I like to communicate is that “good for you” foods also taste great—there doesn’t need to be a trade-off, as the following pasta recipe proves.

Pasta With Garlic and Olive Oil

  • Pasta with Olive oil and garlic Pasta With Garlic and Olive Oil

    This recipe hails from one of my favorite regions in one of my favorite countries—Lazio, Italy. Fresh-Pressed Olive Oil Club members recently got to savor a bold Canino olive oil from a wonderful producer, an agricultural cooperative of small local farmers who carry on their respective family traditions and passion for growing olives. I’m happy to say that this classic pasta dish is divine with any of the Club’s extra virgin olive oils! You probably have the ingredients in your kitchen already, so you can be enjoying it tonight. For an even healthier meal, choose whole wheat pasta or an alternative made with legumes, such as black beans or yellow pea protein.


    • 1 tablespoon coarse salt
    • 1 pound pasta, any variety, fresh or dried
    • 1/3 cup extra virgin olive oil, plus more for drizzling
    • 4 cloves garlic, minced
    • 1 fresh pepperoncini or red chile pepper, thinly sliced, or crushed red pepper flakes to taste 
    • 1/4 cup chopped flat-leaf parsley


    Step 1

    Bring a large pot of cold water to a boil over high heat and add the salt. Add the pasta and cook until al dente, about 7 or 8 minutes. 

    Step 2

    While the pasta is cooking, heat a large skillet and, when very warm, add the olive oil, garlic, and pepper (if using crushed flakes, add them later, as noted below). Cook over medium heat until the garlic softens and starts to turn color, about 5 minutes. 

    Step 3

    Use tongs to transfer the pasta to the skillet along with a 1/4 cup of its cooking water. Toss well to coat the pasta in the oil and continue cooking for another 2 minutes until the pasta water is just about fully absorbed (if using pepper flakes, add them now). Sprinkle with the parsley, drizzle with more olive oil, and serve.

    Yields 4 servings

Fitness Flash: Get Help for Tech Neck

Protecting Brain Health Through Diet

More Benefits of the Olive Oil Lifestyle

The Study: “Association of Mediterranean-DASH Intervention for Neurodegenerative Delay and Mediterranean Diets With Alzheimer Disease Pathology,” Neurology, March 8, 2023.

The Findings: People who eat diets rich in green leafy vegetables as well as other vegetables, fruits, whole grains, olive oil, beans, nuts, and fish may have fewer amyloid plaques and tau tangles in their brain—signs of Alzheimer’s disease—than people who do not consume such diets.

The Report: According to an American Academy of Neurology report on the study, researchers looked at how closely people followed the Mediterranean diet and a variation called the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet. Although similar, the Mediterranean diet recommends vegetables, fruit, and three or more servings of fish per week, while the MIND diet prioritizes green leafy vegetables like spinach, kale, and collard greens, along with other vegetables and berries over other fruit, and recommends one or more servings of fish per week. Both the MIND and Mediterranean diets recommend small amounts of wine.

“These results are exciting—improvement in people’s diets in just one area, such as eating more than six servings of green leafy vegetables per week, or not eating fried foods, was associated with fewer amyloid plaques in the brain similar to being about four years younger,” says study author Puja Agarwal, PhD, of RUSH University in Chicago. 

The study shows an association between regularly consuming these diets and fewer Alzheimer’s disease plaques and tangles, although it doesn’t establish a cause-and-effect relationship. “While our research doesn’t prove that a healthy diet resulted in fewer brain deposits of amyloid plaques, also known as an indicator of Alzheimer’s disease, we know there is a relationship, and following the MIND and Mediterranean diets may be one way that people can improve their brain health and protect cognition as they age,” explains Dr. Agarwal.

The study involved 581 people with an average age of 84 at the time of their diet assessment who agreed to donate their brains at death to advance dementia research. Participants completed annual questionnaires asking how much they ate of food items in various categories. The participants died an average of seven years after the start of the study. Right before death, 39 percent had been diagnosed with dementia. When examined after death, 66 percent met the criteria for Alzheimer’s disease.

At autopsy, researchers examined participants’ brains to determine the amounts of amyloid plaques and tau tangles (both are found in the brains of people with Alzheimer’s disease but may also be found in the brains of older people with normal cognition). They then looked back at the food questionnaires and ranked the quality of diet for each person.

For the Mediterranean diet, there were 11 food categories. Participants were given a score of zero to 55, with higher scores if they adhered to the diet in these categories: whole grain cereals, fruits, vegetables, legumes, olive oil, fish, and potatoes. They were given lower scores if they ate red meat, poultry, and full-fat dairy products.

For the MIND diet, there were 15 categories. Participants were scored one point each for eating from 10 brain-healthy food groups: green leafy vegetables, other vegetables, nuts, berries, beans, whole grains, fish, poultry, olive oil, and wine. They lost a point if they ate greater than recommended amounts of foods in five unhealthy groups: red meats, butter and margarine, cheese, pastries and sweets, and fried and fast food.

Researchers then divided participants into three groups for each diet and compared those in the highest groups to those in the lowest groups. For the Mediterranean diet, people in the highest group had an average score of 35, while those in the lowest group had an average score of 26. For the MIND diet, the highest group had an average score of nine while the lowest group had an average score of six.

After adjusting for age at death, sex, education, total calorie intake, and whether people had a gene linked to a greater risk of Alzheimer’s disease, researchers found people who scored highest for adhering to the Mediterranean diet had average plaque and tangle amounts in their brains similar to being 18 years younger than people who scored lowest. Researchers also found people who scored highest for adhering to the MIND diet had average plaque and tangle amounts similar to being 12 years younger than those who scored lowest.

When looking at single diet components, the researchers found that people who ate the highest amounts of green leafy vegetables—seven or more servings per week—had plaque amounts in their brains corresponding to being almost 19 years younger than people who ate the fewest (one or fewer servings per week). “Our finding that eating more green leafy vegetables is in itself associated with fewer signs of Alzheimer’s disease in the brain is intriguing enough for people to consider adding more of these vegetables to their diet,” says Agarwal. “Future studies are needed to establish our findings further.”

Note: A limitation of the study was that participants were mostly white, non-Hispanic, and older, so the results cannot be generalized to other populations.

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