Wednesday, June 19, 2024
HomeHealthWarning on bone health and plant-based diets

Warning on bone health and plant-based diets

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Respected UK whole food plant-based doctor, Shireen Kassam, has reiterated concern about the important need for healthy plant-based eating following the recent release of a new study which has once again raised concerns around bone health for people on a plant-based diet,

The analysis comes from the UK Women’s Cohort Study, which included 26,318 women aged 35–69 years at recruitment between 1995–1998. Diet was assessed once at recruitment.

Participants were classified as regular meat-eaters (46.2%; ate meat ≥ 5 times/week), occasional meat-eaters (26.5%; ate meat < 5 times/week), pescatarians (12.8% ate fish but not meat), vegetarians (14.5%; ate eggs or dairy but not meat or fish), or vegans (did not eat meat, fish, eggs, or dairy). Vegans were combined with the vegetarian group due to the small number of vegan participants (n = 130). Dietary patterns were correlated with the risk of hip fractures.

During the 22.3 years of follow-up, 3.1% of the cohort experienced a hip fracture. The results showed a 33% increased risk of hip fractures in the vegetarian group compared to the regular meat-eaters. This was after taking into account other factors which may influence hip fracture risk, including age, alcohol consumption, smoking, exercise habits, menopausal status and socioeconomic status. No increased risk was found in the occasional meat-eaters or pescatarian groups.

Dr Kassam says notable aspects of this study include the fact that diet quality overall appears adequate for the vegetarian group as they were consuming a median of 27g/day of fibre. However, 12% of vegetarians were not consuming sufficient amounts of protein (<0.75g/kg/day), suggesting they may not have included enough protein rich foods such as legumes, including soya and nuts in their diet.

She says vegetarians did have a significantly lower BMI when compared to regular meat eaters (23.3 vs 25.3), but this lower BMI did not seem to explain all the higher risk of fracture. However, there were very few cases of hip fracture in vegetarian participants with a BMI >23.5 (n=29), so lower BMI can not be completely discounted as a risk factor for fracture.

Vegetarians were consuming sufficient calcium (1138mg/day) thus pointing to a cause other than low calcium. However, vegetarians had lower intakes of vitamin B12 and vitamin D. Dairy consumption per se was clearly not a protective factor for bone health in this cohort.

On a positive note, the prevalence of cancer, cardiovascular disease and type 2 diabetes was almost 50% lower in the vegetarian group compared to regular meat-eaters (5.8% vs 10.2%).

“My take-home messages are that bone health does require particular focus when consuming a plant-based diet as this is the third study cohort to report concerns. This is especially important for women,” Dr Kassam said in a Facebook post on Plant-based Health Professionals, UK.

Her advice is:

  • Ensure your diet is healthy and meets your calorie and nutrient requirements, including protein, calcium, vitamin B12 and vitamin D.
  • Ensure you are consuming enough protein by emphasising protein-rich foods at every meal.
  • Avoid or minimise dietary components that are known to negatively impact bone health, including alcohol, tobacco smoking, caffeine, fizzy drinks and added salt.
  • Weight-bearing physical activity and muscle strengthening exercise is vitally important for bone health throughout the lifespan and may need to be emphasised more for those on a plant-based diet.
  • Don’t be underweight, and it may also be beneficial to aim for the middle of the BMI range
  • Don’t be disheartened. Plant-based diets have significant advantages for cardiometabolic health.

Dr Kassam says she will provide more detail in her next weekly review. In the meantime, this summary from the study authors is a balanced appraisal.

The Conversation article

The full paper

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