Grilled tofu and dragon fruit buddha bowl. Getty image.A recent long-term study on diet and bone health spawned a slew of misleading headlines claiming that vegans are at significantly greater risk of bone fracture than nonvegans. However, it is first worth noting that the study is based on a cohort of roughly 55,000 people, among which only 2,000 participants were vegans. And out of a total reported 3,941 fractures over 17 years, 147 of these fractures occurred in vegans. (More on the numbers perspective here.)
While vegans in the study did have a higher incidence of bone fracture than nonvegans, they also had a lower intake of calcium than the other dietary groups participating in the study. But this is not because plant-based foods are lacking in calcium. It is easy to get enough calcium, protein, and other nutrients on a plant-based diet— many fruits, vegetables, nuts, grains and seeds are abundant in calcium and other important vitamins and minerals (the nutrients obtained from meat and dairy come from plants those animals ate, after all)— but many people who switch to a vegan diet do not spend enough time researching which foods they need to eat to ensure that they are getting enough necessary vitamins and minerals.
Additionally, vegans in this study had a lower Body Mass Index (BMI), with significantly fewer vegans in the overweight or obese category. Dr. Justine Butler notes, “So one difficulty [the researchers] had was matching enough vegans and meat-eaters with a similar BMI to make meaningful comparisons. Very few vegans were in the higher BMI category and only a relatively small number of meat-eaters had a low BMI.”
It is medically established that people with more adipose tissue (body fat) are less susceptible to bone fracture. The proper conclusion for the media to report, then, would not be that vegans are inherently at greater risk of bone fracture; it would be that diets with insufficient calcium intake lead to greater risk of bone fracture; and that people with greater body fat levels are less susceptible to bone fracture.
Several doctors also note the potential significance of the role of Hormone Replacement Therapy in menopausal women in the study cohort. Participants in this study were overwhelmingly white females: 42,400 females vs. 12,500 males were studied. The lifetime risk of fracture for a 60-year-old woman is approximately 44%, nearly double the risk of 25% for a man of the same age. Dr. Butler states, “Hormone replacement therapy (HRT) protects against bone loss during menopause and only 5.6 per cent of the vegan women in this study reported taking it compared to 26.7 per cent of the meat-eating women.”
A Closer Look With Dr. Neal Barnard
For better insight into this study, as well as the media’s anti-vegan skewing of the findings, let’s check in with a couple more doctors. Here’s Dr. Neal Barnard of the Physicians Committee for Responsible Medicine.
His main takeaways on the study findings, as explained in the video above:
1. “Vegans are less likely to be obese.” In this particular study, meat-eaters had a much higher prevalence of overweight and obesity, which reduces fracture incidence due to a “cushioning effect.” Dr. Barnard explains: “If you’ve got a lot of body weight and fall down, you are less likely to break a hip. If you’re at a healthy weight and you fall down, you are more likely to break a hip. We’ve known for a long time that heavy people are less likely to break a bone. However, this is not a good reason to gain weight.” Nor is it an argument against eating a plant-based diet; on the contrary, lower BMI and plant-based diets are both associated with significant health benefits, including reduction in incidence of diabetes, high blood pressure, high cholesterol, heart attack, stroke, and some types of cancer.
2. Vegan study participants had a lower calcium intake than nonvegans. The average calcium intake in the vegan group was slightly less than 600 mg/day. This is below the recommended amount. Both the World Health Organization recommendation and the U.S. recommended daily amount (RDA) for calcium in adults is 1000 mg. It is easy to get enough calcium on a vegan diet. As PCRM says, All the nutrients you need to build strong bones can be found by eating plants, without the negative health risks from milk and dairy products. See their list of recommended foods for calcium and building strong bones.
3. “Vegans in this study were substantially more physically active” than non-vegans. “If you are out riding a bike or roller-blading… you are more likely to break a bone.” Of course, there are plenty of sedentary vegans, so, once again, a more honest headline reporting on this study would have focused on exercise level and bone fracture risk, in addition to BMI and calcium intake. Moreover, “Exercise is one of the most effective ways to build bone density, or the measurement of the amount of minerals contained in a certain volume of bone. Exercise will also help decrease the risk of osteoporosis.”
Dr. Garth Davis Weighs In
Final thoughts
The EPIC-Oxford study (EPIC stands for European Prospective Investigation into Cancer and Nutrition) has been widely received by vegan and nonvegan doctors alike as a credible analysis from a reputable source— the University of Oxford— but in addition to the media’s overwhelmingly misleading and consistently anti-vegan bias in reporting on this and other studies like it, it’s also worth noting that another recent Oxford report urged, in an article entitled Plant-based foods are good for both health and the environment:
“Foods associated with improved health (whole grain cereals, fruits, vegetables, legumes, nuts and some vegetable oils high in unsaturated fats, such as olive oil) have among the lowest environmental impacts. Foods with the largest negative environmental impacts—unprocessed and processed red meat—were also consistently associated with the largest increases in disease risk.”
The American Academy of Nutrition & Dietetics, the U.S.’s oldest, largest and foremost authority on diet and nutrition, has also officially recognized that humans have no inherent biological or nutritional need for animal products, stating:
“It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.”
In her analysis of the study, Dr. Justine Butler concludes:
“If you look around the world, most osteoporosis occurs in countries that consume the most dairy. So milk does not prevent bone loss. Of course we need calcium, but a healthy vegan diet provides the whole package of nutrients needed for healthy bones: vitamins A, C, K and the B group, calcium, magnesium, potassium, selenium, boron, iron, copper and zinc.
Research shows that physical activity, especially weight-bearing exercise such as walking, climbing stairs and dancing, is the most critical factor for maintaining healthy bones, followed by improving diet and lifestyle. This means eating plenty of fresh fruit and vegetables, wholegrains, pulses, nuts and seeds and cutting down on caffeine and avoiding alcohol and smoking.
All major health bodies agree, a healthy, varied vegan diet can support good bone health and protect you from disease.”
Further reading: Catching Up With Science: Burying the “Humans Need Meat” Argument
