Proactive Medicine: Getting Some Sunshine and Vitamin D to Fight COVID-19

 Shining the Light on Getting Enough Vitamin D to Counter COVID-19

Evelyn E. Smith

While up to now public health physicians and task forces have concentrated on self-isolation and quarantine as a means of controlling the COVID-19 virus, increasingly independent sources have started to urge readers to take a proactive approach to combatting COVID-19 by making sure they have a healthy immune system to start with since a healthy immune system as well as a body free from co-morbidities is better equipped to fight all respiratory viruses. Moreover, this spring and summer everyone can immediately start to take three proactive steps to enhance over-all physical health:

1)     Ask for a blood test to check for possible Vitamin D deficiency, and then maintain appropriate Vitamin D levels by getting enough sunlight for one’s skin type; and if necessary, take the appropriate level Vitamin D supplement upon the advice of a physician since it is also most important not to take too much Vitamin D in supplement form.

2)    Follow a regular aerobic exercise routine outdoors for thirty minutes five days per week*.

3)    Maintain a healthy diet, which if adhered to, will bring down high blood pressure and improve cardiovascular health.

Today’s topic, however, shines the light on the easiest  and perhaps most inexpensive step anyone can take—getting enough Vitamin D, which, of course, results when both the liver and the kidneys take the Vitamin D found in sunlight, and to a lesser extent in fatty fish, eggs, and fortified milk and cereals, and convert it into calcium.

Thus, the cure for vitamin D deficiency and a weak immune system is for the most part is a relatively simple one:

a)    Get enough sunshine every day when the sun shines during the spring and summer months.

b)    As necessary (upon the advice of one’s physician) take the appropriate level of a Vitamin D supplement. No peer-reviewed studies or randomized trials as yet exist as to whether spending time in the sun or taking a Vitamin D supplement will decrease the mortality rate of COVID-19, but improving the immune system's health will not hurt anyone. 

Pointing Out Vitamin D Deficiency Might Be Controversial:

Here is where some controversy comes into play since darker skin tones absorb less Vitamin D found in sunlight than lighter skin tones:

As Found on YouTube:

Campbell, John. (2020, April 15). Vitamin D and immunity, lots of evidence. YouTube. https://www.youtube.com/watch?v=GCSXNGc7pfs

British medical practitioner Dr. John Campbell argues that evidence is strong enough that Vitamin D deficiency might increase the severity of viruses that listeners should ask their physician whether they should be taking vitamin D supplements during the COVID-19 pandemic. He also points to Public Health England’s recommendation that everyone in England should take a daily 10 microgram supplement in autumn and winter. Moreover, Campbell also recommends that individuals with darker skin tones take a Vitamin D supplement throughout the year.

Translation: Instead of taking only the Politically-Correct sociological approach adhered to by American academics to explain the discrepancy in the mortality rates between African, Hispanic, and Native Americans and European Americans [living in food deserts, undue stress caused by social inequality, prevalence in service occupations], some British physicians, including John Campbell, are adhering to a natural selection argument for taking Vitamin D during the COVID-19 pandemic: Light-skinned people manufacture more Vitamin D than those individuals with darker skin tones, which protect them from the sun. Additionally, during the winter months, or when everyone is confined to the indoors, a large percentage of the population of all skin tones is likely to be Vitamin D deficient—a condition that correlates--but does not necessarily cause--various comorbidities, or preexisting health conditions.

Then again, food deserts do exist in the United States as does social inequality. However, taking an adult multi-vitamin everyday might be the prudent course of action for all adults to do. 

Moreover, additional research also suggests another explanation for the higher mortality rate among African Americans:

Kiddie, Jason. (2020, April 8).  A possible explanation for the COVID-19 racial disparity.  Medpage Today. https://www.medpagetoday.com/infectiousdisease/covid19/86023

A deficiency of L-arginine and subsequently nitric oxide is another possible explanation for why African American death rates are higher than white American death rates. 

Online Nutrition Sources

Espostio, Lisa and Kotz, Deborah. (2018, July 18). How much time in the sun do you need for vitamin D.  U.S. News & World Report. https://health.usnews.com/wellness/articles/2018-07-18/how-much-time-in-the-sun-do-you-need-for-vitamin-d

In the winter, everyone living in the Northern Hemisphere 37 degrees North of the equator (or anywhere North of Atlanta, Georgia) does not get enough sun in the winter months to absorb enough Vitamin D from sunlight. Although over sun exposure increases the risk of melanoma and skin cancers, Northern Europeans should allow for 10 to 15 minutes of unprotected sun exposure between 10 a.m. to 3 p.m. However, Hispanic, Native, and African Americans as well as Europeans who tan easily may need 15 to 20 or more minutes of sun exposure mid-day to achieve this dosage. Since individuals deficient in Vitamin D double their risk of dying from heart disease, most studies now recommend achieving a balance between getting in a little midday unprotected sun exposure most days of the week and the habitual use of sunscreen.

Grant, William B, Lahore, Henry, et al. (2020, April 12). Evidence that Vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. https://www.mdpi.com/2072-6643/12/4/988

Even though some studies and clinical trials report that adequate intake of Vitamin D reduces the risk of influenza, others do not report these findings. Grant and his fellow researchers, however, point to the lower number of COVID-19 cases in the Southern Hemisphere during the first three months of 2020 as well as to findings that vitamin D deficiency contributes to acute respiratory distress syndrome (ARDS), and that case fatality rates increase with age and with chronic disease comorbidity as circumstantial proof that relates low levels of Vitamin D with increased mortality rates associated with COVID-19. The researchers thus recommend that those most at risk for COVID-19; for example, the elderly and those diagnosed with comorbidities, take 10,000 I.U. of Vitamin D supplements to rapidly raise their levels of Vitamin D. Even so, the researchers nevertheless caution that controlled trials and larger population studies will need to prove this hypothesis.

Bottom Line:  Consult a physician before taking the appropriate-level Vitamin D supplement.  Remember more Vitamin D, however, is not necessarily better, for it may damage the liver and kidneys.

Public Health England Asks Brits to Take Vitamin D

Hancocks, Nikki. (2020, April 23). Public Health England extends vitamin D supplement advice during lockdown. Nutraingredients. https://www.nutraingredients.com/Article/2020/04/23/Public-Health-England-extends-Vitamin-D-supplement-advice-during-lockdown

England’s National Health Service is advising its entire population to take a daily supplement of 10 micrograms of Vitamin D to avoid Vitamin D deficiency since they might not be getting enough sunlight during the quarantine. This advisory particularly applies to high-risk individuals and the elderly. New research findings are not the reason for this advisory, however.

Mayor, Susan. (2016, July 21). Public health England recommends vitamin D supplements in autumn and winter. The BMJ [British Medical Journal]. https://www.bmj.com/content/354/bmj.i4061

Since diet alone will not allow the English to achieve their recommended daily dose of Vitamin D during the autumn and winter months, Public Health England recommends that both children and adults should take a daily vitamin D supplement during that part of the year.

Medical Sources for General Audiences

Hensrod, Donald. (2017, April 25). Mayo Clinic Q. and A. How much vitamin D do I need? Mayo Clinic. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-how-much-vitamin-d-do-i-need/

Vitamin D. deficiency is associated with osteoporosis, multiple sclerosis, rheumatoid arthritis, chronic pain, and such comorbidities as diabetes, high blood pressure, cardiovascular disease, and some cancers, although correlation does not mean that vitamin D deficiency causes these conditions. The skin absorbs most Vitamin D from the sun, although individuals wearing a sunscreen with an SPF factor of 8 or greater and dark-skinned individuals may not be absorbing enough Vitamin D from sunlight. Foods with vitamin D include egg yolks, cheese, cod-liver oil, beef liver, and fatty fish, such as tuna, salmon, sardines, herring, and mackerel. U.S. markets also fortify milk with Vitamin D.

Kubala, Jillian. (2020). Can Vitamin D lower your risk of COVID-19? Healthline. https://www.healthline.com/nutrition/vitamin-d-coronavirus

Currently, no known preventive measures apart from social distancing and maintaining proper hygiene practices can keep anyone from coming down with the Sars-COVID-19 virus; however, some research shows that maintaining a healthy level of vitamin D generally guards against respiratory diseases since Vitamin D enhances the function of immune cells.  Conversely, studies associate low levels of Vitamin D with an increased susceptibility to infectious diseases and immune-related disorders, including tuberculosis, asthma, COPD, and viral and respiratory infections. Taking a Vitamin D supplement also reduces the morality rate in older adults. Typically, the prescribed supplement dosage is between 1,000 and 4,000 I.U. daily.

Note:  Everyone should consult a physician before taking Vitamin D supplements, so as not to overdose oneself.

Sunlight destroys coronavirus quickly, say US scientists. (2020, April 24).  https://medicalxpress.com/news/2020-04-sunlight-coronavirus-quickly-scientists.html?utm_source=join1440&utm_medium=email&utm_placement=itkst

Medical science has long understood that radiation damages any virus’s ability to reproduce, but now researchers have determined the exact amount of time it takes.

COVID-19’s half-life, or the time it takes for it to reduce to half its amount on hard surfaces is 18 hours with a room temperature of between 79 to 75 degrees Fahrenheit, or 21 to 24 degrees Celsius, but this time span reduces to just six hours when the humidity rises to 80 percent and to just two minutes when the virus is in the presence of direct sunlight.  As for an aerosol (suspended in air) COVID-19 virus, while its half-life is one hour when the temperature is between 70 to 75 degrees Fahrenheit  with 20 percent humidity, in the presence of sunlight, the time it takes to destroy the virus drops to one and a half minutes.

PubMed, National Library of Medicine Sources

It is a little too soon for a peer-reviewed, randomized clinical trial on whether Vitamin D works, but rest assured one is in the works.

Parva, Nareen R., Tadepalli, Satish, et al. Prevalence of Vitamin D deficiency and associated risk factors in the U.S. population. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634

Parva et al note that 82.1 percent of African Americans are Vitamin D deficient, and 62.9 percent of Hispanic Americans are Vitamin D deficient. Additional risk factors for Vitamin D deficiency include obesity, not enough regular milk consumption, and a formal education that does not go past secondary school. The primary source of Vitamin D is sunlight while fatty fish, such as salmon and tuna, is another natural source of Vitamin D.

In other words, researchers urge that everyone who lives at a Northern latitude, all dark-skinned people, and those with pre-existing conditions should take Vitamin D supplements while light-skinned people, who are likely to sunburn, should limit their mid-day sun exposure during the summer months while at the same time getting enough Vitamin D.

Editorial Note: Of course, a Mediterranean diet that features the consumption of fatty fish  at least twice a week would probably decrease the cholesterol levels of all concerned**; and scheduling a brisk 30-minute mid-day walk outdoors might lower everyone’s risk of cardio-vascular disease, hypertension, and diabetes.

Teymoon-Rad, M., Shokri, F., et al. (2019, March). The interplay between vitamin D and viral infections. Reviews in Medical Virology. doi. 10 1002/my2032. https://www.ncbi.nlm.nih.gov/pubmed/30614127

Regularly monitoring Vitamin D levels is necessary, even though post-modern medicine has yet to fully understand the affect Vitamin D has on viral infections.

Vitamin D on prevention and treatment of COVID-19 z9COVITD-19). (Updated: 2020, April 17). ClinicalTrials.gov. U. S. National Library of Medicine. https://www.clinicaltrials.gov/ct2/show/NCT04334005

In a currently ongoing, 200 participant, randomized clinical trial, “The Effect of Vitamin D Administration on Prevention and Treatment of Mild Forms of Suspected Covid-19”, researchers have hypothesized that the administration of Vitamin D supplements will produce significant improvement in the heath status for those patients diagnosed with non-severe, symptomatic COVID-19.  Similar research relates reduced levels of Vitamin D with the cause of bovine coronavirus in the past. The targeted completion data for this trial is 30 June 2020.

______

*Laskowski, Edward R (2016).  How much should the average adult exercise every day.  Health-lifestyle/ Fitness. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916

The United States Department of Health and Human Services recommends taking 150 minutes of moderate aerobic exercise, or 75 minutes of strenuous aerobic exercise, during a week as well as the strength training of all major muscle groups twice weekly.  This might mean taking a brisk walk for thirty minutes five days a week.

***Fish and Omega-3 fatty acids. (2017, March 23).  American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

The American Heart Association recommends eating two servings a week of fatty fish (salmon, mackerel, herring, trout, sardines, albacore tuna), although the public should avoid eating fish with the highest potential or mercury contamination.

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Relatively Cost-Effective Long-Term Fixes for Climate Change

Technology Can Help Bring Down

 CO2 Levels, But No Immediate 

Magic Fixes Exist

Evelyn Smith

"Keep calm and carry on" encouraging both entrepreneurrs and state, federal, and local goverments to fund research and development of inexpensive, practical alternative energy resources and transportation.  Of course, every change will bring about a reaction, so don't be surprised if these fixes bring about unanticipated circumstances.  For example, China's one child policy caused a drastic drop in its population as well as an unequal balance in working-age males and females.

1) As of yet, electric batteries are available to fuel jet planes only in short-distance, low occupancy experimental flights, so only expect to see their use in commuter planes in the near future while carbon credits don’t put the jet-fuel emissions back in a large-long distance jet's fuel tank.  For the foreseeable future, most commercial jets will still use petroleum-based fuel because of battery-storage problems; there simply isn't enough space on board to carry sufficient batteries to fuel a long-range  flight (https://www.theguardian.com/business/2019/sep/19/aviations-flight-towards-low-emissions-only-fuels-the-crisis).

2) Meanwhile, high-speed rail projects, such as the privately-funded Texas Central project between Dallas and Houston, Texas, due to begin operation in 2025, will be a more opportunity-cost-effective and “ecologically friendly” way to transport travelers between relatively close urban areas instead of driving the route since it cuts the time down as well as the individual's fuel cost (https://www.texascentral.com/project/).  Similarly, Europe’s Channel-route from London to Paris to Amsterdam is already in operation (https://www.eurail.com/en/get-inspired/trains-europe/high-speed-trains/eurostar).  Virgin has also developed a high-speed train that runs between Miami and Fort Lauderdale, Florida, but it hasn’t achieved the high speeds envisioned yet (https://www.visitflorida.com/en-us/travel-ideas/brightline-rail-service-south-florida.html) just as Amtrak’s “high-speed” route between Washington and Boston isn’t all that speedy for most of its heavily-traveled route: (https://www.boston.com/travel/travel/2019/04/25/amtrak-to-increase-high-speed-train-service-between-boston-and-washington-dc). Unfortunately, high costs have run California’s high-speed project off the rails (https://www.latimes.com/local/california/la-me-california-high-speed-rail-consultants-20190426-story.html).  Rail systems, high speed or otherwise, of course are easiest to build on relatively flat land and only make economic sense if they serve a relatively dense urban population.  Accordingly, Japan's famed bullet trains pioneered high-speed rapid transit, and China has similarly developed a wide-ranging network of high-speed trains since for China it's more important to keep a large segment of the population employed than to budget construction costs. 

3)  For now, for the most part, wind farms and solar energy cells produce electricity only when the sun shines, or the wind blows. As for the Toyota Prius, Chevy Bolt, or Nissan Leaf’s battery’s power, it obtains its night-time and rainy-day energy from whatever energy source the local electric utility uses unless a home, business, or school has a self-sustaining solar energy system equipped with Tesla-style batteries as well as a hefty bank account or sufficient credit to fund the project.   Texas power plants, for instance, obtain most of their power from comparatively-clean-burning, low-cost natural gas, even though Texas is the nation’s leading wind power-producer (https://www.eia.gov/state/?sid=TX).  However, home owners might wish to hold off on installing a solar power system since solar panels are being developed that will actually hold more solar power than the ones currently in use (https://news.energysage.com/what-is-the-power-output-of-a-solar-panel/ and https://conservationfolks.com/efficient-solar-energy-compared-to-other-renewable-energy/).

4) Nuclear energy does produce “clean” energy if a country accepts the slight risk of a Chernobyl-style nuclear meltdown. France, for example, obtains 75 percent of its electricity from nuclear sources ( https://www.world-nuclear.org/information-library/country-profiles/countries-a-f/france.aspx).

5) Hydro-electric energy is limited to a few locations where falling water generates enough force to produce energy (https://www.usgs.gov/special-topic/water-science-school/science/hydroelectric-power-how-it-works?qt-science_center_objects=0#qt-science_center_objects). The United States has already taken advantage of most of  the sites that can economically produce hydro-electricity, but China is continuing to develop these dams: (https://www.ucsusa.org/resources/environmental-impacts-hydroelectric-power).

6) However, the US is blessed with a safety net--relatively clean-burning petroleum and natural gas obtained from shale that will buy the US time to come up with non-CO2-emitting solutions before environmentalists take energy consumption (or non-consumption) back to the horse and buggy era (https://naturalgasnow.org/co2-emissions-resume-falling-due-to-shale-revolution/). Accordingly, the US won't be importing much petroleum for the foreseeable future. Europe and Asia, however, aren't so lucky and will have to rely on Middle Eastern petroleum. Similarly, it's easier for California (on the wrong side of the Rocky Mountains from all that North Dakota and Texas shale) to get its petroleum from Alaska than the other lower 48 states. Remember that both Germany and Japan's lack of access to a ready supply of petroleum was a contributing cause for World War II (http://www.questioz.com/questioz-research-articles/the-impact-of-german-and-japanese-petroleum-strategy-on-world-war-ii).

7) As an opportunity-cost public expense, public transportation (rapid-transit systems) only works in urban areas where it costs less, and/or it is more convenient to take the subway, bus, or urban rail system than having the freedom of coming and going in a private car particularly for middle-class families or workers.  For instance, taking the subway in New York, Washington, D.C., Chicago, or San Francisco or the London Underground or the Paris Metro is both convenient and economical.  However, these systems are only economically feasible in densely-populated urban areas.

8) As for going vegetarian, while limiting beef consumption and eating oily fish several times a week will bring down cholesterol levels, cattle and sheep as well as any other grazing animals deposit grass seeds in their dung, thus helping to reseed prairie grasslands (http://www.beefresearch.ca/blog/let-cattle-do-the-seeding/), so abstaining from meat doesn’t necessarily preserve grasslands since the animals and the plants in these systems share a symbiotic relationship. Sorry, AOC.

9) Finally, don’t fret too much about the population explosion since all of Europe, China, Japan, the Koreas, the United States, Australia, and Canada have fertility rates below the replacement level, and once fertility rates start going down, they ordinarily keep decreasing:  https://yaleglobal.yale.edu/content/replacement-fertility-declines-worldwide; https://www.cnn.com/2019/01/10/health/us-fertility-rate-replacement-cdc-study/index.html).  Urbanization and the education of women as well as economic recessions have resulted in these lower birth rates in both already industrialized and developing countries.

10) This however also creates a problem (or an opportunity), for as the adult population ages, countries will have to cope with a lower tax base and a smaller population of working adults to help pay for its health care, so they will need to raise the age of retirement gradually, considering the current life span of most older adults in post-industrialized countries as well as find ways of forestalling or preventing Alzheimer's, Parkinson's, and other debilitating diseases (https://www.economicshelp.org/blog/8950/society/impact-ageing-population-economy/).  Aging populations also buy less consumer goods and use transportation less than younger populations; and as a general rule,  upper-middle-class older adults stop investing in stocks once they reach retirement and instead place their money in annuities or other-less risky ventures (https://www.seniorliving.org/finance/investing/).

In summary, any time a country's secondary and university and technical school enrollment increases, it brings down birth rates while nutrition and preventive health care lower mortality rates in adults over age 65.  An aging population should also have a positive impact on any human-produced climate change.

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Throw Out Grooming Products that Contain DEA or Diethanolamine

Washing  Those Dangerous Shampoos Right  Out of Your Hair!

Today I received an unsolicited e-mail that ask me to click on a link that promised to tell me which shampoos caused memory loss. I get a lot of these perhaps because of my age (67), but also because for several years I published this very same blog that’s now (more or less) inactive because it was largely a self-help blog for preventing Alzheimer’s, and I hadn’t seen anything lately that wasn’t the same old same old—Mediterranean diet, staying involved with other people, and exercise—and I started working more or less full time after Mother died in March 2014. Well, after 30 minutes, the audio still had not told me which shampoos to avoid, so I started googling.

Bottom line: Avoid shampoos with DEA or Diethanolamine because they might result in memory loss since DEA blocks the absorption of choline, which is vital to brain development. Studies also link DEA to cancer. Look at the labels on all shampoo, toothpaste, and soap products as well as deodorants and don’t assume they are safe just because the FDA has approved them, and they are labeled “organic”, or they are marketed for use in babies and children. Do some Online research because studies often appear Online before stores take these products off their shelves. BTW, if you are wondering, yes, I immediately checked the shampoo bottle on the side of my tub, although I haven’t checked the ingredients on my bar of Ivory soap quite yet. Generally, the less expensive products (such as Suave) are less likely to contain DEA, so consumers might save some money as well.

See the following links:

Radcliffe, Shawn. (2013, August 29). Cancer-causing chemical found in 98 shampoos and soaps. Healthline. https://www.healthline.com/…/cancer-dangerous-chemical-foun…

Toxicity Effects. CAS Registry Number: 111-42-2. Names. (n. d.). National Toxicology Program. U.S. Department of Health and Human Services. NIEHS.NIH.gov. https://tools.niehs.nih.gov/cebs3/ntpviews/index.cfm…

Gives peer reviewed alternative an in vitro tests, case reports, human and animal exposure studies.

Zelsel, Steven H. (n. d.). Diethanolamine, brand development and adult memory. Granttome. National Institutes of Health.http://grantome.com/grant/NIH/R21-ES012997-03

Contains abstract and bibliography.

P. S. -- I still can't find a list of names of products containing DEA just their manufacturers.

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Understanding Studies that Link the Long-term Use of PPI's with Dementia in Context

Why Does the Habitual Use of PPI’s Increase the Risk for Dementia?

Evelyn Smith

M.S. in Library Science, University of North Texas (2012)

This week’s headlines that correlate the use of proton pump inhibitors with an increased risk for dementia should serve as a warning against reading medical reports in isolation and out of context, even though the information stems from a peer-reviewed JAMA Neurology article. 

Gomm, W., von Holt, K., Thomé, F.  (2016, February 16).  Association of proton pump inhibitors with risk of dementia:  A pharmacoepidemiological claims data analysis.  JAMA Neurology. doi:10.1001/jamaneurol.2015.4791. [Abstract only; published Online first].  Retrieved from http://archneur.jamanetwork.com/article.aspx?articleid=2487379

After conducting a longitudinal, cohort study using observational data from Germany’s statutory health insurer from 2004 to 2011, researchers found that out of the 73,679 participants free of Alzheimer’s at baseline, those regularly receiving proton pump inhibitor medications had a “significantly increased risk of incident dementia” (Gomm, 2016, February 16, Abstract only).

However, reading this abstract does not tell the whole story since the data only links the incidence of dementia with the habitual use of PPI’s--not the reasons why the dementia occurs:  One of which is a vitamin B₁₂ deficiency (Jameson, 2013, December 13), although taking PPI’s also meddles with beta and tau amyloid plaque levels (Badiola, 2013).  Of course, making permanent life style changes, such as losing access weight, might also decrease the need for taking PPI’s as well as decrease the risk for dementia.

See also:

Link between indigestion drugs and dementia ‘inconclusive’.  (2016, February 16).  NHS Choices.  Retrieved from http://www.nhs.uk/news/2016/02February/Pages/Link-between-indigestion-drugs-and-dementia-inconclusive.aspx

A peer-reviewed German study sensationalized in The Daily Mail and The Daily Telegraph  that associated a 44 percent higher risk of dementia with the habitual, long term use of PPI’s is accurate, although this risk might have other plausible causes (Link, 2016, February 16, para. 4-5).  Adults age 75 and older taking PPI’s ordinarily are in poorer health and are thus taking more medications than their peers not suffering from acid reflux (Link, 2016, February 16, para. 6).  The NHS therefore recommends that those currently taking PPI’s should not stop taking them without consulting a physician since this could acerbate their digestive problems (Link, 2016, February 16, para. 7). 

Adhering to a healthy [Mediterranean or DASH] diet, watching one’s weight, regularly exercising [30 minutes four or five days a week], consuming alcohol in moderation, not smoking, and controlling blood pressure all reduce the risk for dementia, according to the NHS (Link, 2016, February 16, para. 35).

The NHS article provides links to the original JAMA Neurology article as well as to the Daily Mail and Daily Telegraph articles.  All the same, while reassuring, the British give few details, so keep reading.

Locke, Tim. (2016, February 17).  Proton pump inhibitors linked to dementia.  Heartburn/GORD Health Center.  WebMD.  Retrieved from http://www.webmd.boots.com/heartburn-gord/news/20160217/proton-pump-inhibitors-linked-to-dementia

A new study has again confirmed a link between proton pump inhibitors taken for heartburn and acid reflux with an increased risk of Alzheimer’s; however, it does not determine whether PPI’s directly cause dementia in senior adults (Locke, 2016, February 17, para. 1-2). The study which looked at the medical data on 73,679 Germans age 75 and older between 2004 and 2011 found that those who used a PPI for at least 18 months had a “significantly higher risk” of dementia than those not taking these medications.

Researchers also took into account additional risk factors, like diabetes, depression, stroke, and being prescribed additional drugs, but they didn’t consider the participants’ educational levels, so critics claim that the study has only established a statistical link between PPI’s and Alzheimer’s (Locke, 2016, February 17, para. 6-9  & 14 & 16). The use of PPI’s is also higher among smokers and the obese, which are also risk factors for dementia.  Moreover, PPI users are ordinarily in poorer health and thus at greater risk for diabetes and stroke (Locke, 2016, February 17, para. 17-18).

The more education one has, the less likely he or she is to succumb to dementia because presumably this knowledge should translate into better lifestyle habits.  All the same, most older and middle-aged adults can point to numerous university-educated, individuals, who died from Alzheimer’s.  Moreover, only a randomized trial could conclusively prove that taking PPI’s for a year and a half or more drastically increases an older adult’s chances of developing dementia.

Molchan, Susan. (2016, February 16).  Our psychiatrist-reviewer analyzes news about proton pump inhibitors and dementia risk.  Heathewsreview.  Retrieved from http://www.healthnewsreview.org/2016/02/our-psychiatrist-reviewer-analyzes-news-about-proton-pump-inhibitors-dementia-risk/

Susan Molchan points out that an association between the regular use of PPI’s and a “significant” increase for the  risk of dementia doesn’t indicate cause and effect since only a randomized, controlled trial can prove more than a statistical correlation.  Moreover, she cautions that the abstract itself overstates the study’s findings (Molchan, 2016, February 16, para. 4-5).

Even so, the use of PPI’s by adults over age 75 might increase their risk of dementia for various reasons:

PPI’s cross the blood-brain barrier;

They lower vitamin B12 levels, which if too low can cause dementia;

They interact with amyloid and tau protein.

Nevertheless, the habitual use of PPI’s might in itself might not raise the risk of dementia since older adults often take lots of drugs for lots of different health conditions, such as cardiovascular disease, that also increase the risk of dementia (Molchan, 2016, February 16, para. 6). 

Molchan then goes on to note that the Food and Drug Administration has long warned that the use of PPI’s is associated with an increased risk of fractures, unhealthy magnesium and calcium levels, and severe diarrheal infections.  She also notes that physicians routinely over prescribe PPI’s  (Molchan, 2016, February 16, 7-8).

But, the statistical link is still troubling:

Proton pump inhibitors may be associated with increased dementia risk. (2016, February 15).  Neuroscience News.  Retrieved from http://neurosciencenews.com/proton-pump-inhibitor-dementia-3663/

Researchers affiliated with the German Center for Neurodegenerative Diseases in Bonn, using data culled from patient diagnoses and drug prescriptions found a statistical link between the regular use of proton pump inhibitors (at least one PPI prescription in each quarter of an 18-month interval) and an increased risk of dementia (Proton pump, 2016, February 15, para. 3).  The study examined the records of 218,493 Germans aged 75 and older, identifying 29,510 patients who eventually developed dementia (Proton pump, 2016, February 15, para. 4).  Regular users of PPI’s had a 44 percent increased risk of dementia, although the authors were only able to integrate some other risk factors in their analysis (Proton pump, 2016, February 15, para. 6-7).  A copy of the abstract follows Neuroscience News’ synopsis of the JAMA Neurology article.

Fortunately, some commentary delves a little deeper, noting that research associates regularly taking PPI’s with vitamin B ₁₂ deficiency, and they also warn that diet and weight control might contribute both the reasons for acid reflux and dementia.

Thomson, Dennis. (2016, February 15).  Popular heartburn drugs linked to risk of dementia.  Healthday.  CBSNews.  Retrieved from http://www.cbsnews.com/news/heartburn-drugs-ppi-prilosec-nexium-prevacid-risk-of-dementia/

German researchers have found that adults aged 75 and older who regularly take proton pump inhibitors, including Prilosec, Nexium, and Prevacid, had a 44 percent increased risk of dementia compared with those who didn’t use PPI’s, although correlation in this longitudinal study doesn’t necessarily mean causation (Thomson, 2016, February 15, para. 1-3).

These results are surprising enough that one leading expert on aging plans to share these results with older patients taking PPI’s since they may change the levels of amyloid beta and tau protein association with Alzheimer’s as well as lead to vitamin B12 deficiency, which previous researchers have long linked with cognitive decline (Thomson, 2016, February 15, para. 7 & 15). Some experts, however, caution that since researchers as yet do not know why the aging brain deteriorates, those taking PPI’s should not be too concerned since the researchers failed to control for diet and weight as risk factors (Thomson, 2016, February 15, para. 24-30).  

Nevertheless, those patients who want to “ease off” taking PPI’s can reduce excess acid and prevent acid reflux by eating smaller meals, cutting out caffeine and chocolate, and sitting upright for two or three hours after eating (Thomson, 2016, February 15, para. 22).

All the same, the PPI lansoprazole does enhance the production of beta amyloid plaque in lab rats:

Badiola N., Alcalde, V., and Pujol, A., et al. (2013). The proton-pump inhibitor Lansoprazole enhances amyloid beta production. PLoS ONE, 8(3), e58837. doi:10.1371/journal.pone.0058837.  [Open Access].  Retrieved from http://bio.davidson.edu/courses/genomics/2013/Systems.pdf

In cell models, the proton-pump inhibitor lansoprazole enhances Ab37, Ab40 and Ab42 production as well as lowering Ab38 levels in amyloid cell models. Additionally, acute lansoprazole treatment promotes higher Ab-40 levels I the brains of wild and transgenic mice.

Moreover, a previous, much smaller German study did control for such risk factors as ApoE status, taking additional medications, depression, diabetes, and cardiovascular disease.

Haenish, B., Von Holt, K., and Wiese, B. (2015, August).  Risk of dementia in elderly patients with the use of proton pump inhibitors.  European Archives of Psychiatry and Clinical Neuroscience, 265(5), pp. 419-28.  doi: 10.1007/s00406-014-0554-0.  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25341874

Assessing the association between the use of PPI’s and dementia in older adults, the German Study on Aging, Cognition and Dementia in Primary Care Patients analyzed 3,327 community dwelling adults 75 years of age and older, noting that participants receiving a PPI medication had a “significantly increased risk” of dementia compared with non-users after considering factors such as age, gender, ApoE status, additional medications, depression, diabetes, ischemic heart disease, and stroke (Haenish, 2015, August, Abstract, p. 419).

Furthermore, previous American studies emphasize that the use of PPI’s leads to the inability to effectively absorb vitamin B₁₂:

Jameson, R., Lam, M. P. H., and Schneider, J. L., et al. (2013, December 13).  Proton pump inhibitor and histamine ₂ receptor antagonist use and vitamin B₁₂ deficiency.  JAMA, 310(22), pp. 2435-2442).  [Full text]. doi: 10.1001/jama.2013.280490.  Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=1788456

Proton pump inhibitors and histamine ₂ receptor antagonists not only suppress the production of gastric acid, but their regular use potentially leads to “malabsorption of vitamin B₁₂, according to an examination of electronic pharmacy, laboratory, and diagnostic records of 25,956 Northern California patients ensured through Kaiser Permanente.  Among patients diagnosed with incidental vitamin B₁₂ deficiency, 12 percent received two or more years of PPI prescriptions, and 4.2 percent received two or more years of H₂RA’s, and 83.8 percent didn’t take either PPI or H2RA prescriptions (Jameson, 2013, December 13, Abstract, para. 1-5, p. 2435).  “Left untreated, vitamin B₁₂ deficiency can lead to dementia, neurological damage, and other complications, which may be irreversible” (Jameson, 2013, December 13, Abstract, Conclusion, para. 7, p. 2435).

A New York Times article as well as an Alzheimer Research Foundation article also note the increased risk for vitamin B12 deficiency as pointed out by an earlier American study:

See also:

Saint Louis, Catherine. (2013, December 10).  Acid-suppressing drugs linked to vitamin B12 deficiency.  Well.  New York Times.  Retrieved from http://well.blogs.nytimes.com/2013/12/10/acid-suppressing-drugs-linked-to-vitamin-b12-deficiency/?_r=0

Individuals of all ages who use proton-pump inhibitors and histamine ₂ receptor antagonists two years or longer increase their risk for vitamin B₁₂ deficiency, which, in turn, can sometimes lead to anemia, neurological problems, or dementia (Saint Louis, 2013, December 10, para. 1-2). 

Thus, those taking these medications should be routinely screened for vitamin B₁₂ deficiency, according to Douglas A. Corley, who along with his colleagues at Kaiser Permanente examined the pharmaceutical and diagnostic records of 25,956 Californians  diagnosed with Vitamin B ₁₂ deficiency between 1997 and 2011 (Saint Louis, 2013, December 10, para. 3 & 5).  Researchers found that patients who took PPI’s for more than two years were 65 percent more likely to be deficient in vitamin B₁₂ as well as those who took higher dosages of PPI’s (Saint Louis, 2013, December 10, para. 6).

The benefits of PPI’s need to be weighed against their risks, including bone fractures, pneumonia, severe diarrhea, and vitamin B₁₂ deficiency.  Other factors, such as adhering to a vegetarian diet might also explain a vitamin B₁₂ deficiency (Saint Louis, 2013, December 10, para. 13-14). Additionally, when researchers analyzed 20 randomly-selected charts of PPI-using patients, they discovered that 25 percent had anemia and 15 percent suffered from memory loss.  Accordingly, physicians need to counsel patients on the overuse and abuse of PPI’s (Saint Louis, 2013, December 10, para. 15-16).

Netzer, W. J. (reviewer).  (2016). How heart burn drugs may lead to memory problems.  The Fisher Center for Alzheimer’s Research Foundation.  Retrieved from https://www.alzinfo.org/articles/how-heartburn-drugs-may-lead-to-memory-problems/

The use of both over the counter and prescription proton pump inhibitors used to treat gastro-esophageal reflux disease and stomach and intestinal ulcers and histamine ₂ receptor antagonists leads to an increased risk of low vitamin B₁₂ levels, which, in turn, correlates with an increased risk of dementia.  When low vitamin B₁₂ deficiency goes untreated, it can lead to irreversible dementia, neurological damage, and anemia (Netzer, 2016, para. 1-3). 

Four in ten Americans suffer from acid reflux, and thus taking these drugs might put them at additional risk for vitamin B₁₂ deficiency.  Adults over age 50 are particularly at risk for this deficiency because they have problems absorbing vitamin B₁₂ found in fish, meat, and dairy products, so taking vitamin B₁₂ supplements may be necessary (Netzer, 2016, para. 4 & 10).

These findings come from a survey of 25,956 Kaiser Permanente patients diagnosed with vitamin B12 deficiency, 12 percent of whom had been taking PPI’s for at least two years compared with 7.2 percent who weren’t taking any acid reflux medications. Although higher dosages of PPI’s put patients more at risk, this increased risk decreases after older adults stop taking PPI’s (Netzer, 2016, para. 5 & 6).  Thus, physicians should prescribe the lowest workable dosages for PPI’s as well as discussing the risk associated with them (Netzer, 2016, para. 7-8). 

Folic acid, Vitamin B6 and Vitamin B12 help keep “brain areas critical for memory and thinking in good health” particularly in those seniors already diagnosed with mild cognitive impairment (Netzer, 2016, para. 9).

Thus, physicians should monitor the levels of vitamin B12 in their patients who are taking either over-the-counter or prescription PPI’s.  Additionally, users of PPI’s age 50 and older should 1) try to improve the conditions that put them on PPI’s in the first place, better controlling their weight and diet, so they no longer need to take them, and 2) routinely take a vitamin supplement and recognize the signs of vitamin B₁₂ deficiency:

Nazario, Brunilda. (2015, July 23).  Vitamin B12 deficiency.  WebMD., pp. 1-2.  Retrieved from http://www.webmd.com/food-recipes/guide/vitamin-b12-deficiency-symptoms-causes

• Weakness, tiredness, or lightheadedness
• Heart palpitations and shortness of breath
• Pale skin
• A smooth tongue
• Constipation, diarrhea, a loss of appetite, or gas
• Nerve problems like numbness or tingling, muscle weakness, and problems walking
• Vision loss
• Mental problems like depression, memory loss, or behavioral changes

(Nazario, 2015, July 23, p. 2)

All of which means that older adults who use PPI's should take a multivitamin that contains vitamin B12 or a vitamin B12 supplement (Nazario, 2015, July 23, p. 2). 

Finally, the public should be weaned away from the idea that simply popping a pill is the cure for anything since maintaining a healthy mind and body often calls for lifestyle changes.

A Lifetime Diet Emphasizing Vegetables & Fish Slows Cognitive Decline

Eat Your Vegetables and Fish for a Healthy Mind into Old Age

Evelyn Smith, M. S. in Library Science, University of North Texas (2012)

While the news this week focused on how moderate (once a week) fish consumption might possibly slow the onset of Alzheimer's among individuals possessing the APOE gene variant, and last year's headlines emphasized the importance of including dark green leafy vegetables like spinach and kale in a diet as a way to delay cognitive decline, one truth lies behind these studies: A life-long diet that stresses the intake of  dark-green vegetables and fish while limiting the consumption of red meat, poultry, refined sugar, and processed foods can delay and perhaps even prevent cognitive decline. In other words, now more than ever, to use a cliche, "You are what you eat!"

___________

Weekly Fish Consumption May Delay Alzheimer's Disease for 30% of the Population with the APOE Gene

Clare, Martha Clare, Brockman, John, and Schneider, Julie A., et al. (2016, February 2). Association of seafood consumption, brain mercury level, and APOE ε4 status with brain neuropathy in older adults. JAMA, 315(5), pp. 489-497. doi:10.1001/jama.2015.19451. [Open Access]. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2484683#References

Moderate seafood consumption correlates with a lower risk for Alzheimer's. Researchers arrived at this conclusion after an analysis of deceased participants in the Memory and Aging Project neuro-pathological cohort study that took place between 2004 and 2014. After performing autopsies on 286 brains of 554 deceased, predominantly women residents of Chicago, whose mean age at death was 89.9 years, and comparing their answers on a food frequency questionnaire filled out on average 4.5 years earlier, researchers discovered that those participants who ate seafood at least once per week were much less likely to develop Alzheimer's disease. The more seafood the participants consumed, the much less likely they were to develop Alzheimer's. Although the autopsies showed that higher levels of fish consumption correlated with higher levels of mercury in the brain, they didn't correlated with  the type of brain damage associated with Alzheimer's disease. Moreover, taking fish oil instead of actually eating the fish didn't confer the same benefits as actually eating the fish did (Clare, 2016, February 2, Abstract, p. 489).

See also:

Chew, Emily Y., Clemons, Traci E., Agrón, Elvira, et al. (2015, August 25). Effect of Omega-3 fatty acids, lutein/zeaxanthin, or other nutrient supplementation of cognitive function. JAMA, 314 (8), 791-801). doi: 10.1001/jama.2015.9677. [Full text]. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2429713

In a double-masked, randomized trial, retina specialists in 82 United States academic and community medical centers over a five-year period not only observd 4,000 older patients at risk for macular degeneration, but they also administered cognitive tests via the telephone whereupon they discovered that oral Omega-3 fatty acid supplements had no effect on cognitive function (Chew, 2015, August 25, Abstract, p. 791). 

In other words,  eating fish regularly may delay or prevent cognitive decline, but taking fish oil supplements doesn't do so.

______

Kroger, Edeltraut, and Laforce, Robert. (2016, February 2). Fish consumption, brain mercury, and neuropathology in patients with Alzheimer disease and dementia. JAMA, 315(5), pp. 465-466. doi:10.1001/JAA.2016.0005. [Editorial extract only]. Retrieved from http://jama.jamanetwork.com/article.aspx?articleid=2484661

Alzheimer's is fast becoming an increasing concern as an aging population worldwide is living longer, which means there is a need for proactive preventive strategies to combat Alzheimer's; for example, adhering to a Mediterranean-style [or MIND or DASH] diet with regular fish intake and limiting red meat intake can benefit older adults seeking to maintain brain health.  Research studies have consistently associated a regular intake of n-3 fatty acid fish with a slowing of cognitive decline and a decreased risk for Alzheimer's (Kroger, 2016, February 2, Extract, p.489).

Go Fish: Popular Takes On the Importance of the MAP Study:

Gregory, Andrew. (2016, February 2). Seafood really is brain food say scientists who food it could reduce Alzheimer's risk . Mirror. Retrieved from http://www.mirror.co.uk/news/technology-science/science/seafood-really-brainfood-say-scientists-7295129

Although researchers are careful not to extend their findings on the benefits of regularly consuming seafood to a general population, a study published February 2, 2016, in the Journal for the American Medical Association reveals that for older adults with the APOE gene, eating at least one serving of seafood weekly greatly reduced their risk for developing Alzheimer's (Gregory, 2016, February 2, para. 1-6). However, investigators also stressed that the consumption of omega-3 fatty acid fish should be part of a balanced diet and that taking fish-oil supplements alone (rather than eating fish) does not confer the same brain-healthy benefits (Gregory, 2016, February 2, para. 7 & 9). They also admitted that the brains of those individuals who ate the most fish had the higher levels of mercury; but at the same time, they stressed that this didn't correlate with the changes that Alzheimer's makes in the brain (Gregory, 2016, February 2, para. 10). While a mix of factors, including age, lifestyle, and genetic risk, seems to determine Alzheimer's risk, evidence suggests that maintaining cardiovascular health by adhering to a balanced diet and regular exercise is also good for the brain (Gregory, 2016 February 2, para. 11-12).

Park, Alice. (2016 February 2). Fish, mercury and Alzheimer's risk. Time. Retrieved from http://time.com/4201808/fish-mercury-and-alzheimers-risk/

While regular consumption of seafood protects the heart and brain, an analysis of the autopsies on the brains of the participants in a Rush University study also shows that eating fish at least once weekly accumulates mercury in the brain. However, for the 30 percent of the population who have at least one copy of the APOE gene variant, eating seafood regularly just might outweigh the risk of brain toxicity since doing so lowers the amount of Alzheimer's-related proteins in the brain (Park, 2016, February 2, para. 1-5). Moreover, even individuals without this gene might also benefit from eating seafood regularly (Park, 2016, February 2, para. 6). Thus, the study eases fears that mercury in seafood causes dementia (Park, 2016, February 2, para. 8).

Pollario, Karen. (2016, February 2). Seafood may help those at risk of Alzheimer's: Study also finds mercury in fish isn't linked to dementia symptoms. WebMD. Retrieved from http://www.webmd.com/alzheimers/news/20160202/seafood-might-protect-brain-in-people-at-genetic-risk-for-alzheimers

Data released from the Memory and Aging Project published in the JAMA February 2, 2016, issue posits that mercury in fish does not lead to cognitive decline while a healthy diet featuring regular seafood consumption might stave off Alzheimer's disease in adults who have the APOE gene (Pollario, 2016, February 2, para. 1, 11, & 14).

Even though the autopsied brains of older study participants who regularly consumed more seafood had greater levels of mercury in their brains, researchers did not find a link between these higher levels of that heavy metal and the brain damage that is typical in Alzheimer's patients (Pollario, 2016, February 2, para. 2). Thus, older adults with the APOE gene who regularly eat fish while also adhering to a healthy diet do not need to be overly concerned about mercury contamination while they are reaping the protective effects of a diet with moderate levels of seafood.   For these individuals, regularly eating fish correlates with a decreased risk for Alzheimer's and a slower rate of Alzheimer's disease progression (Pollario, 2016, February 2, para. 5-6 & 9).

In the case of the MAP participants, the questionnaire they filled out to measure seafood consumption provided them with four choices: 1) Tuna sandwich, 2) fish sticks, cake, or sandwich, 3) fish served as a main dish, 4) or shrimp, lobster, or crab. Researchers also not only analyzed tissue samples from their autopsied brains for metal concentrations, but  they also looked for evidence of strokes and micro-strokes, and the plaque and tangles associated with Alzheimer's as well as the Lewy bodies found in the brains of individuals diagnosed with Parkinson's (Pollario, 2016, February 2, para. 12-13).

By comparing the regular diets of older adults with their subsequent brain autopsies, researchers determined that eating one or more servings of seafood a week meant that older adults with the APOE gene were less likely to develop Alzheimer's. They didn't associate the same protective link that lowers the odds of developing Alzheimer's for individuals without the APOE alle. However, they did find that those brains with higher levels of the fatty-acids found in plants had fewer strokes (Pollario, 2016, February 2, para. 15-16). Thus, since few middle-aged and older adults have been tested for the APOE gene, adopting a diet that features fresh vegetables and fruit as well as one or two serving of fish weekly is a prudent step to take if one wants to prevent or delay dementia.

Eating Fish Is Only Part of Adhering to a Mostly Vegetarian MIND or Mediterranean-style Diet

Feart, C. Samieri, C., and Alles, B., et al. (2013, February). Potential benefits of adherence to the Mediterranean diet on cognitive health. The Proceedings of the Nutrition Society, 72 (1), pp. 140-52. [Abstract Only]. doi: 10.1017/S0029665112002959. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23228285

A Mediterranean diet characterized primarily by the consumption of plant foods, olive oil, and a low to moderate intake of fish, and low-levels of consumption for both meat and poultry as well as a low to moderate consumption of wine during meals correlates with a decline in the risk for dementia (Feart, 2013, February, Abstract, p. 140).

The MIND Diet recommends, '"Eat this, not that!"

Hosking, D. E. Nettlebeck, T., and Wilson, C., et al. (2014, July 28). Retrospective lifetime dietary patterns predict cognitive performance in community-dwelling older Australians.  British Journal of Nutrition, pp. 112(2), 228-37. doi: 10.1017/0007114514000646.  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24709049

In a cognitively-healthy sample of 352 Australians aged 65 and older, after controlling for such factors as current diet, age, gender, years of education, smoking, income level, physical activity, and the inheritance of the APOE gene, the survey documented that those Australians who spent a life time taking their coffee with sugar and eating a high-fat diet exhibited slower reaction times, poorer working and short-term memories, retrieval fluency, and reasoning skills than those who ate more vegetables and non-processed foods. These dietary choices had a positive effect on their perceptual speed and retrieval frequency (Hosking, 2014, July 28, Abstract, p. 228).

Morris, M. C., Tangney, C. C., and Wang, Y., et al. (2015, September). Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 11 (9), pp. 1015-22.  doi: 10.1016/j.jalz.2015.04.011. [Abstract only]. Retrieved from 
http://www.ncbi.nlm.nih.gov/pubmed/26086182

The older adults participating in the Memory and Aging Project study who followed the MIND diet—a combination of the Mediterranean Diet and DASH, a dietary plan used to control hypertension, on average slowed their cognitive decline by 4.7 years (Morris, 2015, September, Abstract, p. 1015).

Unfortunately, this measured approach to diet as a means to slow cognitive decline turned into hyperbole in the following news article. Even so, Hyslop's claims underline the idea that a diet that consists primarily of plant-based foods does slow cognitive decline:  

Hyslop, Leah. (2015, March 31).  Eating spinach every day could*make your brain 11 years younger.  Telegraph.  Retrieved from 

http://www.telegraph.co.uk/foodanddrink/foodanddrinknews/11505924/Eating-spinach-every-day-could-make-your-brain-11-years-younger.html

When researchers at Chicago's Rush University evaluated the diet and health of 950 older adults every day for from two to ten years, they found that eating spinach and or kale once or twice a day experiences “significantly less” cognitive decline even when researchers made allowances for their educational levels, frequency of exercise, and family history of dementia. On average, a diet that emphasized eating dark green leafy vegetables delayed mental decline by 11 years (Hyslop, 2015, March 31, para. 2-5). Lead researcher, Martha Clara Morris, attributed this benefit to the high levels of vitamin K, lutein, folate and beta carotene found in dark green leafy vegetables (Hyslop, 2015, March 31, para. 7).

*Emphasis added.