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How to lower stroke, anxiety disorders risk

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Eating diet rich in nuts, fruits, vegetables, soy reduces the chance of developing diseases
– Gender, poverty, chronic pain, relationship status, others associated with ailments

People who eat a vegetarian diet rich in nuts, vegetables and soy may have a lower risk of stroke than people who eat a diet that includes meat and fish, according to a study published in the February 26, 2020, online issue of Neurology, the medical journal of the American Academy of Neurology.

“Stroke is the second most common cause of death worldwide and a leading cause of disability,” said study author Chin-Lon Lin, M.D., of Tzu Chi University in Hualien, Taiwan. “Stroke can also contribute to dementia. If we could reduce the number of strokes by people making changes to their diets, that would have a major impact on overall public health.”

The study involved two groups of people from Buddhist communities in Taiwan where a vegetarian diet is encouraged, and smoking and drinking alcohol are discouraged. Approximately 30 per cent of participants in both groups were vegetarians. Of the vegetarians, 25 per cent were men. Researchers defined vegetarians as people who did not eat any meat or fish.

At the start of the study, the average age of all participants was 50 and none had experienced stroke. The first group of 5,050 people was followed for an average of six years. The second group of 8,302 people was followed for an average of nine years. Participants were given medical exams at the start of the study and asked about their diet.

Vegetarians ate more nuts, vegetables and soy than non-vegetarians and consumed less dairy. Both groups consumed the same amount of eggs and fruit. Vegetarians ate more fiber and plant protein. They also ate less animal protein and fat.

Researchers then looked at a national database to determine the numbers of strokes participants had during the course of the study.

In the first group of 5,050 people, there were 54 strokes. For ischemic strokes, which are strokes when blood flow to part of the brain is blocked, there were three strokes among 1,424 vegetarians, or 0.21 per cent, compared to 28 strokes among 3,626 non-vegetarians, or 0.77 per cent. After adjusting for age, sex, smoking and health conditions like high blood pressure and diabetes, researchers found vegetarians in this group had a 74 per cent lower risk of ischemic stroke than non-vegetarians.

In the second group of 8,302 people, there were 121 strokes. For both ischemic and hemorrhagic strokes, also called bleeding strokes, there were 24 strokes among 2,719 vegetarians, or 0.88 per cent, compared to 97 strokes among 5,583 non-vegetarians, or 1.73 per cent. After adjusting for other factors, researchers found vegetarians in this group had a 48 per cent lower risk of overall stroke than non-vegetarians, a 60 per cent lower risk of ischemic stroke and a 65 per cent lower risk of haemorrhagic stroke.

“Overall, our study found that a vegetarian diet was beneficial and reduced the risk of ischemic stroke even after adjusting for known risk factors like blood pressure, blood glucose levels and fats in the blood,” said Lin. “This could mean that perhaps there is some other protective mechanism that may protect those who eat a vegetarian diet from a stroke.”

One limitation of the study was that the diet of participants was only assessed at the start of the study, so it is not known if participants’ diets changed over time. Another limitation was that study participant did not drink or smoke, so results may not reflect the general population. Also, results from the study population in Taiwan may not be generalizable worldwide. Finally, there could be other factors, not accounted for, that might affect stroke risk.

Also, new research from the Canadian Longitudinal Study on Ageing shows that adults who have low fruit and vegetable intakes have a higher likelihood of being diagnosed with an anxiety disorder.

The study was published in the International Journal of Environmental Research and Public Health

“For those who consumed less than three sources of fruits and vegetables daily, there was at least at 24 per cent higher odds of anxiety disorder diagnosis,” says study lead Karen Davison, health science faculty member, nutrition informatics lab director at Kwantlen Polytechnic University, (KPU) and North American Primary Care Research Group Fellow.

“This may also partly explain the findings associated with body composition measures. As levels of total body fat increased beyond 36 per cent, the likelihood of anxiety disorder was increased by more than 70 per cent,” states co-author Jose Mora-Almanza, a Mitacs Globalink intern who worked with the study at KPU.

“Increased body fat may be linked to greater inflammation. Emerging research suggests that some anxiety disorders can be linked to inflammation,” says Davison.

Other factors associated with anxiety disorders among mid-age and older Canadians

In addition to diet and body composition measures, the prevalence of anxiety disorders also differed by gender, marital status, income, immigrant status and several health issues.

One in nine women had an anxiety disorder compared to one in fifteen men.

“Our findings are in keeping with previous research which has also indicated that women are more vulnerable to anxiety disorders than men,” says co-author Karen Kobayashi, Professor in the Department of Sociology and a Research Affiliate at the Institute on Aging & Lifelong Health at the University of Victoria.

The prevalence of anxiety disorders among those who had always been single (13.9 per cent) was much higher than among those who were living with a partner (7.8 per cent). Approximately one in five respondents with household incomes under $20,000 per year had anxiety disorders, more than double the prevalence of their richer peers.

“We were not surprised to find that those in poverty had such a high prevalence of anxiety disorders; struggling to afford basics such as food and housing causes relentless stress and is inherently anxiety-inducing,” says co-author Hongmei Tong, Assistant Professor of Social Work at MacEwan University in Edmonton.

Individuals with three or more health conditions had fivefold the prevalence of anxiety disorders in comparison to those with no chronic conditions (16.4 per cent vs three per cent). Those in chronic pain had double the prevalence of anxiety disorders in comparisons to those who were free of pain.

“Chronic pain and multiple health conditions make life very unpredictable and can be anxiety-producing. One never knows whether health problems will interfere with work or family responsibilities and many activities become more challenging and time-consuming,” says co-author Shen (Lamson) Lin, a doctoral student at University of Toronto’s Factor-Inwentash Faculty of Social Work (FIFSW).

Immigrants to Canada had a lower prevalence of anxiety disorders compared to their peers born in Canada (6.4 per cent vs 9.3 per cent).

“Immigrants may face a myriad of challenges associated with resettling in a new country, including language barriers, poverty, difficulties in getting qualifications recognized, and limited social support, so it seems counter-intuitive that they should have a lower likelihood of anxiety disorders than those born in Canada. It may be that potential immigrants with anxiety disorders would find the challenges of relocation too anxiety-inducing and would therefore not choose to immigrate, so there is a ‘self-selection’ for those with lower anxiety,” says senior author, Esme Fuller-Thomson, professor at FIFSW and director of the Institute for Life Course & Aging. Fuller-Thomson is also cross-appointed to the Department of Family and Community Medicine and the Faculty of Nursing.

The study team analyzed data from the Canadian Longitudinal Study on Ageing, which included 26,991 men and women between the ages of 45 and 85. The article was published in the International Journal of Environmental Research and Public Health.

An important limitation of the study was that the assessment of anxiety disorders was based upon self-reporting of a medical diagnosis. The authors also conducted multivariate analyses taking into account the use of a family physician in the past year to address the possibility of under-reporting of anxiety disorders among those who rarely visited health professionals. This adjustment was not found to substantially change the associations discussed above.

“It is estimated that 10 per cent of the global population will suffer from anxiety disorders which are a leading cause of disability” says Karen Davison “Our findings suggest that comprehensive approaches that target health behaviors, including diet, as well as social factors, such as economic status, may help to minimize the burden of anxiety disorders among middle-aged and older adults, including immigrants.”


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