Stroke ranks as the second-leading cause of death worldwide as well as the third-leading cause of death and disability combined.1 Women have a greater lifetime risk of stroke than men—in part because women live longer, on average, than men do, and because stroke risk in women rises sharply after menopause.2
A substantial body of evidence shows that the Mediterranean Diet (MeDi) reduces stroke risk in both women and men, but little has been published on the MeDi’s effects by stroke type in women.3 In the US, about 80% of strokes are ischemic—a clot blocks blood flow to or within the brain—and the remainder are hemorrhagic, in which a blood vessel in the brain ruptures and bleeds.4
The journal Neurology Open Access recently published an analysis of data from the California Teachers Study (CTS), which followed more than 130,000 women for more than 25 years, starting in 1995.3 This analysis excluded those with a history of stroke or with missing dietary data, for a total cohort of 105,614 women. Average age at the study’s outset was 52.3
At the start of the study, participants answered a validated dietary questionnaire that asked how often they consumed 103 food and beverage items/groups during the previous year, and in what quantities (small, medium, large serving size). Responses were converted to a score that reflected adherence to the Mediterranean Diet (MeDi), ranging from 0 to 9. Participants were stratified by MeDi scores into low (0–2), moderate (3–5), and high (6–9) MeDi adherence groups: 12.5% low, 57.5% moderate, 30% high.3
MeDi is typically characterized by high intake of fruits and vegetables, legumes, and whole grains, with olive oil as the primary source of fat; a moderate intake of fish; and minimal intake of meat and dairy products. Some versions of the MeDi include moderate alcohol consumption.3
During the 25 years of follow-up, the CTS study population experienced a total of 4,083 stroke events: 3,358 ischemic and 725 hemorrhagic.3
Participants with high adherence to the MeDi had a 23% lower overall stroke risk compared with the low-adherence group. When results were adjusted for patient characteristics, including smoking, BMI, and demographics, overall stroke risk was still reduced by 18% with high adherence to the MeDi. Even a one-unit increase in MeDi adherence was associated with a significant decrease in stroke risk.3
When analyzed by stroke subtypes, higher adherence to the MeDi resulted in a significant decrease in stroke risk for ischemic stroke as well as for hemorrhagic stroke. This effect was seen across premenopausal, menopausal, and postmenopausal women in the study, including participants taking hormone treatment.3
This study, with strengths including a large population, long-range follow-up, and analysis by stroke subtype, adds to the body of evidence of the preventative health benefits of the MeDi and helps identify dietary choices that can help reduce stroke risk in women.3
References:1. Feigin VL, Brainin M, Norrving B, et al. World Stroke Organization (WSO): Global stroke fact sheet 2022 [published correction appears in Int J Stroke. 2022;17(4):478. doi:10.1177/17474930221080343]. Int J Stroke. 2022;17(1):18–29. 2. Rexrode KM, Madsen TE, Yu, AYX, Carcel C, Lichtman JH, Miller EC. The impact of sex and gender on stroke. Circulation Res. 2022;130(4):512-528. 3. Sherzai AZ, Cuble EL, Spielfogel ES, et al. Mediterranean diet and the risk of stroke subtypes in women. Neurol Open Access. 2026;2:e000062. 4. Prabhakaran S, Gonzales NR, Zachrison KS, et al. 2026 guideline for the early management of patients with acute ischemic stroke. Stroke. 2026; doi:10.1161/STR.0000000000000513. Online ahead of print.
Winter Salad Recipe, Spotlight on Homemade Vinaigrettes, Prepping Greens, A New Benefit of Vitamin D, and Aerobics for Knee arthritis
Salads aren’t just for summer, and if one of your New Year’s resolutions is to eat more fruits and veggies, this winter greens recipe fits the bill. I’ve dressed it with a sweet-tart vinaigrette that you can use with a variety of foods for lighter eating. I’m also sharing two new important findings: how vitamin D can help people avoid a second heart attack and a surprising way to manage knee arthritis.
4 to 6 cups baby spinach, baby kale, escarole, or other winter greens, rinsed and dried
2 ripe pears, cored and thinly sliced
Block of Parmigiano-Reggiano or 2 ounces mild blue cheese
Directions
Step 1
Make the vinaigrette: In a medium mixing bowl, whisk together the vinegars, mustard, honey, salt, and garlic. Gradually whisk in the olive oil until the dressing is emulsified. Season to taste with pepper and more salt, if desired.
Step 2
Make the salad: Heat a small sauté pan. When hot, add the nuts and toast for 2 minutes until they become fragrant, tossing frequently; set aside.
Step 3
Divide the greens among 4 salad plates and top with equal amounts of pear slices and nuts. If using Parmigiano-Reggiano, use a cheese plane to make long shavings over each salad. If using blue cheese, crumble it. Drizzle a spoonful of vinaigrette over each salad and pass the rest on the side.
Yields 4 servings
Healthy Ingredient Spotlight
Homemade Vinaigrettes
It’s no secret that most bottled dressings are loaded with sugar, artificial ingredients, and poor- quality oil. On the other hand, it’s so easy to make your own with just a few quality ingredients. Vinaigrettes can be made with a whisk, but using a blender or mini food processor can make fast work of it, especially if some ingredients need to be chopped or minced. As a general rule, you can pulse all the ingredients except the olive oil for a few seconds—let the machine mince any herbs, garlic, or shallots for you. Then with the machine still running, slowly add the olive oil through the feed tube until the vinaigrette is emulsified. Vinaigrette will keep for up to a week in the fridge; shake well or whisk as needed before using.
Quick Kitchen Nugget
Prepping Greens
To maximize taste when making salads, prep your greens by rinsing and drying them in a salad spinner or with an absorbent kitchen towel—dressing coats them better when they’re dry and won’t be diluted by water clinging to the leaves. Rather than simply pouring vinaigrette over your salad, mix it in with two forks or tongs to really dress the greens. Also, keep in mind that vinaigrettes aren’t just for salads—drizzle them over roasted vegetables, grains, and cold meats.
For Your Best Health
A New Benefit of Vitamin D
In a large randomized clinical trial, researchers from Intermountain Health in Salt Lake City found that managing the vitamin D levels of people who experienced a heart attack through a “target-to-treat” approach, with blood levels monitored and dosages adjusted to reach an optimal range, cut the likelihood of a second heart attack by 50%. The findings were presented on Nov. 9 at the 2025 American Heart Association Scientific Sessions in New Orleans.
According to researchers, the results carry global importance, as between one-half and two-thirds of people worldwide have low levels of vitamin D. In the past, most individuals received sufficient vitamin D through sunlight exposure. Today, with lifestyle changes and medical advice aimed at reducing skin cancer risk, people spend less time in the sun and must rely more on dietary supplements such as vitamin D3 to maintain healthy levels.
Low vitamin D levels have long been linked to poor cardiovascular outcomes in observational studies. However, earlier clinical trials that provided standard supplementation doses failed to show measurable reductions in heart disease risk. Intermountain scientists wanted to test a different idea: Rather than giving everyone the same dose, what if supplementation was adjusted to reach a specific healthy vitamin D level?
“Previous studies just gave patients supplementation without regularly checking blood levels of vitamin D to determine what supplementation achieved,” said Heidi May, PhD, cardiovascular epidemiologist at Intermountain and the study’s principal investigator. “With more-targeted treatment, when we checked exactly how supplementation was working and made adjustments, we found that patients had their risk of another heart attack cut in half.”
The Intermountain study, called the TARGET-D trial, ran from April 2017 to May 2023 and included 630 patients who had suffered a heart attack within a month of enrolling. Participants were followed until March 2025 to monitor cardiovascular outcomes.
Patients were randomly assigned to one of two groups: One received no vitamin D management and the other underwent active, targeted vitamin D3 treatment. The goal for the treatment group was to raise blood levels of vitamin D to above 40 nanograms per milliliter (ng/mL). At the start, 85% of participants had blood levels of vitamin D below that threshold. More than half of the patients receiving targeted therapy required an initial dose of 5,000 international units (IUs) of vitamin D3 compared to typical supplement recommendations of 600-800 IUs.
Blood levels of vitamin D were checked annually for those maintaining healthy levels. Patients with lower levels were tested every three months and had their dosage adjusted until reaching the 40 ng/mL target. Afterward, their levels were monitored once a year.
Researchers tracked major cardiac events, including heart attacks, strokes, heart failure hospitalizations, and deaths. Out of 630 participants, 107 experienced such events. While there was no significant difference in the overall risk between the two groups, the chance of having a second heart attack was cut in half among those receiving targeted vitamin D3 treatment.
“We’re excited with these results but know we have further work to do to validate these findings,” said Dr. May. Researchers plan to expand their work with a larger clinical trial to confirm and build upon these findings. “A larger study group will allow us to more fully evaluate whether targeted vitamin D management can reduce not only repeat heart attacks but also other forms of cardiovascular disease,” she said.
Fitness Flash
Knee arthritis? Try Aerobics!
A sweeping review of 217 studies representing 15,684 participants found that aerobic exercises like walking and cycling offer the best pain relief and mobility gains for knee osteoarthritis. Compared to other types of exercise, aerobic training showed the strongest evidence across short- and long-term outcomes. All forms of exercise were found to be safe, but experts recommend making aerobic activity the foundation of treatment as it’s the most effective for easing pain, improving movement, and enhancing overall quality of life.
Osteoarthritis develops when the cartilage cushioning the ends of bones wears down, leading to swelling, stiffness, and discomfort. It can affect any joint, but the knees are most commonly impacted. About 30% of adults over age 45 show signs of knee osteoarthritis on X-rays, and roughly half of them experience significant pain and mobility problems.
Exercise is a cornerstone of osteoarthritis care, yet many medical guidelines lack clear direction on which kinds are most beneficial for knee osteoarthritis specifically. To clarify this, researchers analyzed the effectiveness and safety of several exercise approaches.
The trials varied in quality, but the team assessed the strength of the evidence using the internationally recognized GRADE (Grading of Recommendations Assessment, Development and Evaluation) system. They examined several key outcomes: pain reduction, physical function, gait performance, and quality of life. Each was measured at short-term (4 weeks), mid-term (12 weeks), and long-term (24 weeks) follow-ups. Across these studies, aerobic exercise consistently ranked highest in improving outcomes among all exercise types tested.
Other exercise forms showed value too. Mind-body workouts likely provided a notable improvement in short-term function, neuromotor exercises likely boosted short-term gait performance, and strengthening or mixed routines improved function in the mid-term. Importantly, none of the exercise types resulted in more adverse effects than the control groups, indicating that these therapies are generally safe.
The authors did acknowledge some study limitations. Many results came from indirect comparisons, certain outcomes lacked long-term data, and smaller studies may have influenced some early findings. Despite these limitations, the researchers describe their work as one of the most complete and current evaluations of exercise for managing knee osteoarthritis. They believe the findings, which were published in The BMJ, will help doctors make more-targeted recommendations.
Based on the evidence, the team advises aerobic exercise “as a first-line intervention for knee osteoarthritis management, particularly when the aim is to improve functional capacity and reduce pain” and says if aerobic exercise is not possible owing to individual limitations, “alternative forms of structured physical activity may still be beneficial.”
One of the most powerful polyphenols in olive oil is hydroxytyrosol. Consuming hydroxytyrosol is linked to benefits in neurological, cardiovascular, and metabolic health, and the compound has demonstrated anti-inflammatory, anti-cancer, neuro-protective, and immuno-protective effects. A recently published scientific review in the journal Foods examines the growing body of evidence supporting the characterization of hydroxytyrosol as a “functional food,” with emphasis on its effects on neurological and cognitive processes.
What is it?
Hydroxytyrosol (hi-droxy-TY-roh-sol), abbreviated as HXT, is a phenol, a natural chemical that is both water-soluble and attracted to fats, which means that it can pass through cell membranes. Its chemical structure also explains its strong antioxidant and anti-inflammatory properties. HXT occurs mainly in olives—olive oil, fruit, leaves, and pulp—as well as in red and white wines.
What does HXT do in the brain?
HXT interacts with the brain and its vascular (blood vessel) system in 3 ways: 1) as an antioxidant and anti-inflammatory agent, HXT helps prevent damage to cerebral blood vessels and improves their function; 2) lab studies show that, by reducing oxidation and inflammation, HXT helps maintain the proper functioning of the blood-brain barrier (BBB), a crucial filter inside the brain’s blood vessels that controls what substances enter and exit the brain; 3) in studies in humans, consuming HXT in the form of high-phenolic EVOO resulted in less “leakage” across the BBB and, as reflected in participants’ performance on cognitive tests, improved connectivity between brain regions.
HXT and its metabolites (the components of a substance that are formed when metabolic processes, such as digestion, break it down) are able to cross the BBB to interact with specific brain processes, enhancing protective activity and dampening inflammatory activity that is linked to depression and cognitive decline.
How much HXT is needed to obtain its benefits?
In studies in humans, the above benefits were observed with an HXT intake ranging from 7 to 15 mg/day. In terms of EVOO, this translates to a daily consumption of about 25 to 50 ml of high-phenolic olive oil, or ~2 to 3 tablespoons. Table olives—regardless of their color or brining—also provide an excellent source of HXT.
What’s next for HXT?
This body of promising evidence has intensified interest in the development of HXT-enriched foods and other ways of delivering this health-promoting compound. HXT is highly bioavailable, which means that, after it is consumed and digested, it is readily absorbed and transported by the body. So, for now—perhaps for always—the most effective, efficient, and delicious way to obtain the neuroprotective benefits of HXT is “food-first,” via high-phenolic EVOO.
Reference: Martínez-Zamora Z. Foods 2025;14(21):3624.
Cold Seafood Salad Recipe, Spotlight on Yuzu Rice Wine Vinegar, Overcooking Shellfish, Controlling High Blood Pressure, Plus Exercise and Your Appetite
I love elegant dishes that deliver on taste with a minimum of effort, and my take on a seafood salad is perfect at any time because the ingredients are always available—flash-freezing makes it possible to find them year-round in the freezer case. Another reason to love this dish is that it doesn’t call for any added salt, a contributor to high blood pressure. Read on for other ways to limit sodium in your diet.
Prepare an ice bath: Set out a very large bowl and fill it halfway with water, then add 2 cups of ice.
Step 2
Boil the shrimp in a large pot of water until pink, about 5 minutes; use a large strainer to scoop them out and into the ice bath to cool. Add the calamari rings to the boiling water and cook for 2 minutes; use the strainer to scoop them out and into the ice bath. Turn the heat in the cooking pot down to a simmer, add the scallops, cover, and take off the heat; wait 4 minutes, and then use the strainer to scoop them out and into the ice bath. After 5 minutes, drain the seafood and place in a serving bowl along with the tomatoes and onion rings.
Step 3
Whisk the olive oil, vinegar, and lemon juice in a small bowl. Add the parsley, then pour over the seafood. Toss lightly, taste, and season with pepper and more lemon juice as desired.
Yields 4 servings
Healthy Ingredient Spotlight
Yuzu Rice Wine Vinegar
Each year, as I contemplate the potential vinegar choices for the T. J. Robinson Curated Culinary Selections, I always want to include a rather exotic one to surprise and delight you. Yuzu Rice Wine Vinegar is exactly that.
Rice wine vinegar is such an important ingredient in Asian cooking. It’s made from sake, the beloved rice-based Japanese drink. The sake for this vinegar is American-made, a junmai-grade sake from California. Junmai means that it’s pure—nothing other than rice is added to the fermenting mixture. The rice wine is not seasoned, meaning it has no sugar added; it has just the mellowness that comes from aging.
For a completely one-of-a-kind creation, I had the idea to enhance this vinegar with yuzu. Yuzu is an Asian citrus fruit with a strong perfumed aroma and a highly complex flavor profile with notes of grapefruit, lemon, and mandarin orange—it’s tart, sweet, and floral all at the same time. Its thick and bumpy rind goes from green to yellow as it ripens, and its milky yellow juice has deep flavor. It took a lot of experimenting with proportions to find just the right balance of yuzu juice and rice wine so that both tastes would come through, and then it was rounded out with organic blue agave for a little bit of sweetness. The result is a sweet-tart vinegar with a flavor that will wow you as much as it did me.
Quick Kitchen Nugget
Don’t Overcook Shellfish
No one likes rubbery seafood—one bad experience can turn you off to these gifts from the ocean. It’s especially easy to overcook calamari and scallops since, unlike shrimp, their color doesn’t change dramatically when they’re done. However, they do go from translucent to opaque, often in just a few minutes. If you keep cooking beyond this point, they will become tough. Even if you scoop them out of the cooking liquid, the cooking process will continue until the heat dissipates, which is why I suggest dropping them in an ice bath right away.
Shrimp and whole lobsters will turn a bright red-orange as soon as they’re done. Seafood in the shell, like clams, mussels, and oysters, should be steamed on a rack over simmering water just until their shells open. This can take as little as 5 minutes or up to 10, depending on size, so keep watch. They don’t need the ice bath, but it should be used right away.
For Your Best Health
Controlling High Blood Pressure
Despite strong evidence that salt substitutes can safely lower sodium intake and reduce high blood pressure, very few Americans use them, according to preliminary research presented at the American Heart Association’s Hypertension Scientific Sessions 2025. A new analysis of nearly 20 years of national health data found that usage peaked at just over 5% and then declined, even among those with hypertension. Researchers say this represents a major missed opportunity to improve heart health.
High blood pressure occurs when the force of blood flowing through the blood vessels is consistently too high. High blood pressure can lead to other serious events such as heart attack and stroke. Data from 2017 to 2020 showed that 122.4 million American adults had high blood pressure and that high blood pressure contributed to more than 130,000 deaths. Too much sodium and too little potassium in the diet are risk factors for high blood pressure.
“Overall, less than 6% of all US adults use salt substitutes, even though they are inexpensive and can be an effective strategy to help people control blood pressure, especially people with difficult-to-treat high blood pressure,” said lead study author Yinying Wei, MCN, RDN, LD, and PhD candidate in the departments of applied clinical research and hypertension section, cardiology division, at UT Southwestern Medical Center in Dallas. “Healthcare professionals can raise awareness about the safe use of salt substitutes by having conversations with their patients who have persistent or hard-to-manage high blood pressure.”
Salt substitutes are products that replace some or all of the sodium with potassium. Potassium salt tastes similar to regular salt, except it can have a bitter aftertaste if it’s been heated. Many foods contain some sodium in their natural state; however, the largest amount of sodium comes from processed and packaged foods and meals prepared at restaurants. The American Heart Association recommends consuming no more than 2,300 mg of sodium a day, with an ideal limit of less than 1,500 mg per day for most adults, especially for those with high blood pressure. For most people, cutting back by 1,000 mg a day can improve blood pressure and heart health.
The investigation focused on people with high blood pressure, and an additional analysis was conducted among adults eligible to use salt substitutes, including people with normal kidney function and those not taking medications or supplements that affect blood potassium levels. Some salt substitutes contain potassium, and they can raise blood potassium to dangerous levels in people with kidney disease or those taking certain medications or potassium supplements. Excessive potassium can lead to irregular heart rhythms. People with high blood pressure who are thinking about switching from regular salt to a salt substitute should first consult with a healthcare professional.
The study did have some limitations, said the authors. First, information about salt substitute use was self-reported, so there may have been underreporting or misclassification. In addition, all types of salt substitutes were included in the analysis; therefore, the analysis could not specifically separate potassium-enriched salt from other types of salt substitutes. Finally, the survey data did not capture how much salt substitute the participants used.
“Future research should explore why salt substitute use remains low by investigating potential barriers, such as taste acceptance, cost, and limited awareness among both patients and clinicians,” said Wei. “These insights may help guide more targeted interventions.”
Salt substitutes aren’t the only options for adding more flavor to foods. According to the American Association of Heart Failure Nurses, pure herbs and spices, such as garlic, onion, and chili powder, are great choices. Just make sure you aren’t using garlic salt or onion salt.
Fitness Flash
Exercise and Your Appetite
Researchers at Baylor College of Medicine, Jan and Dan Duncan Neurological Research Institute (Duncan NRI) at Texas Children’s Hospital, Stanford University School of Medicine, and collaborating institutions recently shared new insights into how exercise helps with weight loss. They discovered a mechanism by which the compound Lac-Phe, which is produced during exercise, reduces appetite in mice, leading to weight loss. The findings appeared in Nature Metabolism.
“Regular exercise is considered a powerful way to lose weight and to protect from obesity-associated diseases, such as diabetes or heart conditions,” said co-corresponding author Yang He, PhD, assistant professor of pediatrics-neurology at Baylor and investigator at the Duncan NRI. “Exercise helps [people] lose weight by increasing the amount of energy the body uses; however, it is likely that other mechanisms are also involved.”
The researchers previously discovered that Lac-Phe is the most increased metabolite—a product of the body’s metabolism—in blood after intense exercise, not just in mice but also in people. They had also shown that giving Lac-Phe to obese mice reduced how much they ate and helped them lose weight without negative side effects. But until now, scientists didn’t fully understand how Lac-Phe helps suppress appetite.
“Understanding how Lac-Phe works is important for developing it or similar compounds into treatments that may help people lose weight,” Dr. He said. “We looked into the brain as it regulates appetite and feeding behaviors.”
The researchers studied two types of brain cells in mice: AgRP neurons, which stimulate hunger and are found in the arcuate nucleus of the hypothalamus, and PVH neurons, found in the paraventricular nucleus of the hypothalamus. Normally, AgRP neurons send signals that inhibit PVH neurons, making you feel hungry. But when AgRP neurons are turned off, PVH neurons become more active, reducing appetite.
The team discovered that Lac-Phe directly inhibits AgRP neurons, which in turn activates PVH neurons. This chain of events resulted in the mice eating less. The animals’ behavior remained normal, suggesting that Lac-Phe doesn’t cause unpleasant side effects. “We found that Lac-Phe acts on a protein on AgRP neurons called the KATP channel, which helps regulate cell activity. When Lac-Phe activates these channels in AgRP neurons, the cells become less active,” Dr. He said. “When we blocked the KATP channels using drugs or genetic tools, Lac-Phe no longer suppressed appetite. This confirmed that the KATP channel is essential for Lac-Phe’s effects.”
This research helped explain how exercise can naturally reduce appetite and improve metabolism. “The results also suggest the exciting possibility of targeting this newly discovered mechanism for weight management,” said co-corresponding author Yong Xu, PhD, currently at the University of South Florida.
Although this study focused on mice, the findings are promising for people. Future research will explore how Lac-Phe works in different metabolic states (like obesity vs. leanness), how it travels to the brain, and whether it can be used safely and effectively as a therapy.
