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Vegans at higher risk for bone fractures, the study finds

Significantly lower diets of calcium and protein have also been reported in the diet of non-meat eaters. Despite this previous research, the link between vegetarian diet and fracture risks has been unclear until now, the study said.

“This is the first comprehensive study and the largest study to date that looks at the risk of both total fractures (fractures that occur anywhere in the body) and fractures at different sites in people with different usual diets,” said the study’s lead author, Tammy Tong, a nutrition epidemiologist at the Nuffield Department of Population Health at the University of Oxford, via email.

There were 4.1 more cases in vegetarians and 19.4 more cases in vegans for every 1

,000 people over a period of 10 years.

Diet and bone strength

Nearly 55,000 relatively healthy adults from the UK answered a questionnaire on diet, socio-demographic characteristics, lifestyle and medical history between 1993 and 2001. Researchers categorized them by diet at the time and at follow-up in 2010: meat eaters, fish eaters (pescatarians) vegetarians (no meat or fish but dairy products and / or eggs) and vegans (nothing from animals).
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The authors found 3,941 total fractures by 2016. Compared to meat eaters, vegans with lower calcium and protein intakes had, on average, a 43% higher risk of fractures everywhere and in the hips, legs and vertebrae. Vegetarians and pescatarians had a higher risk of hip fractures than meat eaters, but the risk was partially reduced as the researchers considered body mass index and adequate consumption of calcium and protein. However, the risk was still higher for vegans with these factors taken into account.

“The study results support a growing study of bone health with protein and calcium intake as well as BMI (body mass index),” said Lauri Wright, a registered dietitian nutritionist and chair of the Department of Nutrition and Dietetics at the University of North Florida, who was not involved. in the study. “Protein and calcium are the two main components of bone.”

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The limitations of the study included that most of the participants were white Europeans and women. “The results of this, given the limited participants, cannot be generalized to … other populations, and further study is needed,” said Katherine Tucker, professor of nutritional epidemiology at the University of Massachusetts, Lowell, who was not involved in the study.

The authors also had no data on calcium supplementation or on the causes of rupture, and nutrient intake was reported even instead of objectively measured.

In addition, BMI could partially explain the results, the authors said. Vegans and vegetarians tend to have lower BMI, as was the case in this study. Low BMI has been associated with fractures in some areas, potentially due to factors such as less damping against force when a person falls.

Nutritional risks of plant-based diets

Because the risk differences in vegans remained after BMI and adequate intake of calcium and protein (by milligrams), other factors that were not studied may be important – such as the differences between protein and calcium from animals and from plants.

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“Most of these things are better absorbed from animal food,” Tucker said. “Some vegetarians say,‘ Well, if you look at the dining tables, I have enough calcium. “But calcium in whole grains is bound by phytates and in green leafy vegetables it is bound by oxalates.”

Phytates and oxalates are compounds that bind minerals such as calcium, zinc and iron so that the minerals are not released and are so easily absorbed in the gut. This means that even though spinach and other leafy vegetables have a high calcium content, the oxalates in them prevent the body from absorbing that calcium as much as it could from dairy products.

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The authors did not have dietary quality data, but people on whole foods, nutritional plant-based diets tend to perform better than those who eat the most processed foods.

“Although meat eaters typically use larger amounts of protein, calcium and vitamin D, and the nutrients are more bioavailable (can be used by the body), a person may still be deficient if their food choices are poor,” Wright, who is also a spokesman for the Academy of Nutrition and Dietetics, added via email.

“A deficiency has the same impact on bone health, whether you are a meat eater or a herbivore.”

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“The most important thing about vegetarians and especially vegans,” Tucker said, “is that they have to be very careful about getting the nutrients they lack if they do not include products” rich in them.

Previous consensus on protein was that too much would increase the acid load and therefore leached calcium from our bones and led to brittle bones. However, recent studies have found that “the higher the protein (within normal intake ranges), the better for bones,” Tucker said.

Protein is critical for bone strength, and British vegetarians and vegans have been reported to have lower lean mass and grip strength than people who ate meat – which can affect muscle and grip strength. It can affect the risk of falling and therefore the likelihood of breakage.

Getting important nutrients like protein, calcium, vitamin B12 and vitamin D (essential for calcium absorption) from plants requires larger amounts than what is federally recommended, as plant nutrients are absorbed less easily, Tucker said.

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Strategically approaching a non-meat diet with the help of a dietitian can be your best choice. “There’s a lot of misinformation on the Internet, so you have to be really careful,” Tucker said.

“Definitely get consultation from experts to make sure you not only meet the needs based on the food tables, but you are considering the uptake of these nutrients and the supplemental proteins.”

Nuts and seeds are rich in the supporting nutrients magnesium and potassium. Calcium-enriched soy products with whole foods, such as tempeh and soy milk; corn tortillas; green vegetables; legumes; dairy or non-dairy yogurt; cow’s milk; and high-quality cheeses are good options, Tucker recommends.

Make sure you get enough amino acids, the building blocks of protein, from foods including tofu, tempeh, rice and beans.

Calcium supplements can benefit people with deficiencies, she added, but single-ingredient supplements can disrupt overall nutrient absorption if the dose is too high. Talk to your doctor or dietitian before taking supplements.

Additionally, “considering that low BMI is a risk factor for hip fractures, all people should aim to maintain a healthy BMI (neither under nor overweight),” Tong said.

“The bottom line is that people want answers – vegetarian versus non-vegetarian or this versus that. Or if you eat this food versus it,” Tucker said. “It’s never about a single food or a uniform dietary pattern. It’s about quality.”

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