Mirkin suggests that the apparent effect of nuts may be explained by the presumption that the strict vegetarians in our population who eat no dairy products or eggs may also be the high nut consumers. If this were true, the lack of dairy products and eggs may be protective in the strict vegetarians and yet give the appearance of a protective association with nuts, due to confounding.
We do not agree that this explains our findings for a number of reasons.
First, less than 5% of our population were strict vegetarians, yet 25% of the population were in the high nut consumption category. Forty-five percent of the population were lacto-ovo-vegetarians (consumed meat less than once per week) and about 50% were nonvegetarians. Such a small proportion of strict vegetarians could hardly produce the effects that we observed.
Second, the effect of nuts was also seen among the nonvegetarians (see the
Fraser GE, Sabaté J, Beeson WL. Nuts Do Not Prevent Heart Attacks-Reply. Arch Intern Med. 1993;153(1):125. doi:10.1001/archinte.1993.00410010143019
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