Diet

Nutritional Pearls: Vegetarian/Vegan Diets May Increase Risk of Fracture

 

  • Answer: Vegetarian/Vegan Diets May Increase Risk of Fracture

    Quite a large portion of the nutrition world would like you to believe that a vegan diet is the "best" diet for your health. The truth is the jury is still out. In 2019, I shared with you a prospective study that suggested vegetarians and vegans were more likely to have a stroke than those who ate land animal protein.1

    On the other hand, last year I shared with you the results of an analysis of 3 large-scale, prospective studies that demonstrates quite clearly that contrary to popular belief in some nutrition circles, a vegetarian diet does not reduce the risk of heart disease or stroke much more than other healthy dietary patterns, including the Mediterranean diet.2

    Other studies have suggested that those who avoided land animal protein, but consumed fish or shellfish had lower risk of all-cause mortality and heart disease than vegans.3

    The Research

    Your heart is not the only part of your body that is affected by diet. Today we have the analysis from the EPIC-Oxford study, a large-scale ongoing study out of the United Kingdom that assesses the risk of fracture associated with different dietary patterns.4

    Recruitment for the EPIC-Oxford study took place between 1993 and 2001 and data gathering continues to this day. Nearly 65,000 adult men and women were recruited and responded to detailed dietary, demographic, and health history questionnaires at the start of the study and again in 2010.

    With the dietary questionnaires the authors were able to categorize the participants as meat eaters, fish eaters, vegetarians, or vegans. Through linkage to the National Health Service's hospital records, the authors of the study could identify those participants who were diagnosed with a fracture at any time from recruitment through 2016.

    The authors took into account not only age and gender, but also ethnicity, education level, smoking status, alcohol consumption, and body mass index (BMI). They further controlled for the amount of calcium and protein each participant was consuming (in food) as well as whether they were taking dietary supplements.5

    The Results

    They found that compared with those who consumed both land animal protein as well as fish/shellfish, those who followed a vegan diet were 30% more likely to experience a fracture of any kind, while those who avoided land animal protein but ate fish/shellfish were 6% less likely to experience a fracture. Worse yet, vegans were nearly twice as likely­­–– 94% more likely–– to experience a hip fracture than those who ate land animal protein.

    The question, of course, is why?

    The authors note that those who were not meat eaters had a lower average intake of both calcium and protein and tended to have a lower BMI than meat eaters. It is thought, among other things, that a higher BMI places more stress on the bones and helps keep them strong.

    What’s the Take Home?

    If I were one for cherry-picking my research, I might say this means that being vegetarian or vegan is bad for you. There are risks, after all!

    The truth is that there are risks to almost any diet––even the Mediterranean diet, allows red meat consumption and there are known risks to eating red meat.6

    What I take this to mean is that if you choose to go vegetarian or vegan, it's especially important to make sure you're getting adequate nutrition. Ask your doctor for a referral to a registered dietitian who can help you plan your diet to keep you in the best of health, whether you choose to eat animal protein or not.

    References:

    1. Harlan TS. The health risks for vegetarians. DrGourmet.com. Published: September 11, 2019. Accessed: June 11, 2021. https://www.drgourmet.com/bites/2019/091119.shtml
    2. Harlan TS. Should you go vegetarian or vegan for your heart? DrGourmet.com. Published: June 17, 2020. Accessed: June 11, 2021. https://www.drgourmet.com/bites/2020/061720.shtml
    3. Harlan TS. Vegetarians less likely to die from all causes. DrGourmet.com. Published: July 18, 2013. https://www.drgourmet.com/bites/2013/071713.shtml
    4. Tong TYN, Appleby PN, Armstrong MEG, et al. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Med. 2020;18(1):353. https://doi.org/10.1186/s12916-020-01815-3
    5. Harlan TS. Preventing fracture: more evidence against vitamin supplements. DrGourmet.com. Published: December 3, 2014. Accessed: June 11, 2021. https://www.drgourmet.com/bites/2014/120314.shtml
    6. Harlan TS. Live longer with more plant-based protein. DrGrourmet.com. Published: September 4, 2019. Accessed: June 11, 2021. https://www.drgourmet.com/bites/2019/090419.shtml

     

    Dr. Gourmet is the definitive health and nutrition web resource for both physicians and patients with evidence-based resources including special diets for coumadin users, patients with GERD/acid reflux, celiac disease, type 2 diabetes, low sodium diets (1500 mg/d), and lactose intolerance.

    Timothy S. Harlan, MD, is a board-certified internist and professional chef who translates the Mediterranean diet for the American kitchen with familiar, healthy recipes. He is an assistant dean for clinical services, executive director of The Goldring Center for Culinary Medicine, and associate professor of medicine at Tulane University in New Orleans.