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Reply from author for letter to the editor concerning: Stroke and diets: A review

 Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi; Department of Internal Medicine, College of Medicine, Tzu Chi University, Hualien, Taiwan

Date of Submission01-Jul-2021
Date of Acceptance06-Jul-2021
Date of Web Publication10-Sep-2021

Correspondence Address:
Chin-Lon Lin,
Department of Cardiology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 2, Minsheng Road, Dalin, Chiayi
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/tcmj.tcmj_194_21

How to cite this URL:
Lin CL. Reply from author for letter to the editor concerning: Stroke and diets: A review. Tzu Chi Med J [Epub ahead of print] [cited 2021 Oct 22]. Available from: https://www.tcmjmed.com/preprintarticle.asp?id=325834

Dear Editor,

Thank you for your comments on our article “Stroke and Diets: A Review.” Your points are well taken in that vegans are different from ovo-lactovegetarians because they consume no eggs or dairy products although both groups eat no meat, fish or poultry. In both EPIC-Oxford study [1] and our cohort [2], vegetarians and vegans were combined as one diet group in the statistical analyses, owing to the small number of vegans.

Our cohort [2] is different from other studies (including the EPIC-Oxford), our participants do not smoke, drink alcohol, besides being on Taiwanese diets which (both omnivores and vegetarian) are quite different from the typical Western diets in that they included more soy, rice, wheat, salt but less meat, milk products (cheese) [3]. In our study, both the study and control groups stay on similar diets except the study group omits meat due to religious reasons. This allows us to study the unique contribution of meat to the incidences of stroke. Even though our groups consume very little milk products, strict vegans by definition are rare, therefore we combined both in our study.

As mentioned in the discussion section of our study [2], there are controversies regarding the association between vegetarian diets and hemorrhagic strokes. We believe that other potential confounding factors such as phytochemicals, Vitamin B 12, homocysteine, and especially, alcohol intake should be considered. In the EPIC-Oxford study, nearly 80% of vegetarians in the EPIC-Oxford study drink varying degrees of alcohol but most participants in our studies avoid alcohol.

We agreed totally with your point that there are differences between vegan and ovo-lactovegetarians and further studies are necessary to demonstrate the health effects of eggs and milk products.

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Conflicts of interest

Dr. Chin-Lon Lin, an editorial board member at Tzu Chi Medical Journal, had no role in the peer review process of or decision to publish this article.

  References Top

Tong TY, Appleby PN, Bradbury KE, Perez-Cornago A, Travis RC, Clarke R, et al. Risks of ischaemic heart disease and stroke in meat eaters, fish eaters, and vegetarians over 18 years of follow-up: Results from the prospective EPIC-Oxford study. BMJ 2019;366:l4897.  Back to cited text no. 1
Chiu TH, Chang HR, Wang LY, Chang CC, Lin MN, Lin CL. Vegetarian diet and incidence of total, ischemic, and hemorrhagic stroke in 2 cohorts in Taiwan. Neurology 2020;94:e1112-21.  Back to cited text no. 2
Chiu TH, Huang HY, Chiu YF, Pan WH, Kao HY, Chiu JP, et al. Taiwanese vegetarians and omnivores: Dietary composition, prevalence of diabetes and IFG. PLoS One 2014;9:e88547.  Back to cited text no. 3


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