Nutrition in the News: Is a vegetarian diet bad for your bones?
Is a vegetarian diet bad for your bones?
A new study published in August 2022 found that women who followed a vegetarian diet had a 33% higher risk of a hip fracture compared to meat eaters. https://www.sciencedaily.com/releases/2022/08/220810210326.htm
Before my female vegetarian followers and clients become upset that this is not representative, let me provide my perspective of the findings and how you can ALL optimise your bone health, especially in later life when the risk of bone fractures increases after the menopause.
This was a long-term, in-depth study that followed approx. 26,000 women (aged 36-69 years at the outset) over a 20-year period. It compared the incidence of hip fractures in the following dietary types: occasional meat-eaters (less than 5 servings a week), pescatarians (fish not meat eaters), vegetarians (including a small number of vegans) and regular meat-eaters (more than 5 servings a week). Vegans were combined with the vegetarian group as the numbers were so small.
The team at Leeds University used data from the UK Women’s Cohort Study to investigate possible links between diet and hip fracture risk.
Why is there a link between a vegetarian diet and poor bone health?
Like any diet, a vegetarian diet can be healthy and unhealthy. By avoiding meat and fish, it does not automatically result in an increased intake of vegetables and good fats. Equally, when a diet contains meat or fish, it can still have a high intake of vegetables and good fats.
It is important to look at the diversity of foods eaten, the intake of macro-nutrients (protein, fats and carbohydrates) and micro-nutrient intake (vitamins and minerals) ; then compare to the intake of “unhealthy” foods like sugars, refined grains, processed foods and seed oils.
It is also important to remember that what is a “healthy” and balanced diet for one person, may not be appropriate for another person. We are all unique individuals.
What nutrients are critical for bone health, and do we find them in a vegetarian diet?
Vegetarian diets tend to be associated with a decreased intake of nutrients important for bone strength: protein, calcium, Vitamin B12, Vitamin D (although mostly obtained from sunlight), vitamin K and Omega-3 fatty acids.
Fact: You could have a calcium rich diet but your bones may not be strong
Calcium provides bones with strength and structure, supporting bone density and helping protect against fractures. Dairy is a well known calcium rich food source, together with dark green leafy vegetables, sardines, canned salmon, tofu and edamame beans. But many people now choose non-dairy alternatives like plant milks, so this may have an impact. There is no apparent reason why a vegetarian should be low in calcium if the diet is balanced with dairy, soy based protein sources and has a vegetable rich diet
Protein makes up 50% of bone volume. The bone matrix is continuously remodelling and therefore good protein intake is required throughout life. Approximately 50-60g protein is required per day, and levels tend to be higher in those that eat animal foods or bi-products (like eggs). Bean, pulses and soya based protein intake (in a typical vegetarian/vegan diet) are often much less than the required 50g daily intake.
This is one factor that could lead to a higher fracture risk for vegetarians and vegans. A careful reassessment of protein intake to reach the 50-60g/day is recommended.
Omega-3 fatty acids, especially EPA and DHA can help prevent bone breakdown and help increase calcium absorption. And as vitamin D and K are fat soluble, these fats will aid the absorption of these vitamins from the gut to the bloodstream.
Whilst vegetarians can obtain Omega-3 from walnuts, flaxseeds, chia seeds and dark green leafy vegetables, they do not contain EPA and DHA. Oily fish does contain these essential fats. This is another significant factor. Vegetarians and vegans should supplement algae based EPA and DHA to ensure sufficient intake of these important fats.
Vitamin K is a fat soluble vitamin. There are two types: K1 and K2. K2 is considered to be more protective to bones, helping calcium bind to bones. K1 is found in dark green leafy vegetables, whereas K2 is found mainly in animal products. Vegetarians are at a potential disadvantage here. Eating fermented soya foods like natto and tempeh (not tofu) provides good levels of K2.
Vitamin B12 . Those with low B12 levels were found to have a lower bone density. There is no proven link between the role of B12 with bone health, but the findings should not be ignored. B12 is found mainly in animal foods andin dairy. Very low levels are found in mushrooms, yeast, tempeh and nutritional yeast. Vegetarians and vegans should supplement B12 to avoid deficiency.
Whether you are a vegetarian, vegan, meat eater or pescatarian, it is important to look at the diversity of All the foods you eat to ensure you are obtaining the essential building blocks for bone strength and to supplement those that are missing.
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