By Kelley Herring
Several years ago, a well-known medical doctor – and an outspoken proponent of a vegan diet – suffered a fall in his bathroom. Sadly, the accident left this man with a fractured pelvis, a broken femur and other injuries.
An unfortunate incident like this would normally spark nothing but sympathy. But in this case, it actually stirred a heated debate. That’s because this doctor had used his considerable platform for many years to preach that the best bone-building diet is one based on starchy carbohydrates and complete avoidance of animal foods.
As you are about to learn, the science appears to suggest just the opposite. So, it should come as no surprise that a fair number of critics were quick to point out that a minor fall in the bathroom should not produce enough force to snap the strongest bone in the human body (the femur). And, of course, there were a quite a few refrains of “We told you so.”
Now, it’s certainly not my intention to make light of anyone’s misfortune. And I’m glad to report the doctor did recover from his injuries. But it’s worth investigating what role his diet might have played to weaken his bones and reduce their mineral density.
Fractures are a major cause of morbidity and low quality of life as we age. But that’s not all. In fact, having a hip or vertebral fracture also increases the risk of death by 20% over and above what’s expected in the five years following a fracture.1,2,3
This is why maintaining bone density is critical.
And while many “plant-based” proponents preach that a vegetarian diet is a “cure all” for chronic – including osteoporosis – the research tells a much different story.
Vegans Have DOUBLE the Risk of Fractures of Meat Eaters
A recent study published in BMC Medicine evaluated over 50,000 subjects in the UK. Among the participants, roughly 29,000 ate meat, 8,000 ate fish (but not meat), 15,000 were vegetarians and 2,000 were vegans when the study began.
The researchers followed up with the participants continuously for 18 years. During this time, 4,000 of the subjects experienced bone fractures. The results showed that meat eaters had the lowest risk of fractures among all the groups – while vegans had the highest risk.
In fact, vegans were 43% more likely to have broken a bone. And when it came to hip fractures, vegans were nearly 2.5 times more likely to experience this life-altering injury!4
According to the lead researcher, Dr. Tammy Tong:
“This study showed that vegans, who on average had lower BMI as well as lower intakes of calcium and protein than meat eaters, had higher risks of fractures at several sites.”
A Nutrient Poor Diet Increases the Risk of Osteoporosis
It’s well-known that vegetarian diets contain lower amounts of calcium, vitamin D, vitamin B-12 – all of which have vital roles in maintaining bone health. So, let’s take a look at how each of these nutrients – found abundantly in an omnivorous diet – help to protect bone health as we age:
Calcium is well known as the “bone nutrient”.
And despite the fact we’ve been told that calcium supplements are beneficial, studies show that supplementation does not actually reduce fracture risk.5
However, calcium-rich foods – such as milk and yogurt – have been shown to have bone-loss prevention benefits.6,7 The reason? Dairy foods contain a spectrum of other important nutrients – including vitamin D, protein, potassium and magnesium – that work synergistically to promote healthy bones.8
Vitamin D (cholecalciferol) is another well-known nutrient that enhances mineralization and bone formation.10
As you probably know, vitamin D3 in the diet is obtained from animal sources (fatty fish, egg yolks, and fortified milk) and in much lower quantities as ergocalciferol (vitamin D2) from plant sources, most notably mushrooms that have been exposed to UV light.11
Your best source of vitamin D is still regular, moderate sun exposure (without burning).
Vitamin B12 is available in its natural form exclusively from animal products. Therefore, deficiency is extremely common among vegetarians. And there is significant research which shows the value of this important nutrient in osteoporosis prevention.
An analysis of four studies, published in the Journal of Nutrition & Metabolism showed a 4% lower fracture risk for each 50-pmol/L increase in blood levels of vitamin B-12.12
The Framingham Osteoporosis Study found that plasma vitamin B-12 concentrations of less than 148 pmol/L were significantly associated with lower bone density compared with higher concentrations.13
The National Health & Nutrition Survey study also discovered that bone mineral density is reduced and osteoporosis risk increases with vitamin B-12 deficiency. B-12 is also associated with bone density in a dose-dependent manner. Further, the researchers discovered that osteoporosis and osteopenia were two times more prevalent among those with vitamin B-12 levels in the lowest range.14
The Journal of Nutrition reported that the prevalence of osteoporosis was nearly 7 times higher in women with serum vitamin B-12 concentrations less than 210 pmol/L, compared to those with concentrations of 320 pmol/L or higher.15
Low vitamin B-12 can also lead to elevated homocysteine – a dangerous inflammatory factor associated with fracture risk (possibly due to its impact on weakening collagen crosslinking).16 Elevated homocysteine is also strongly correlated to cardiovascular and neurodegenerative diseases.17
An Ancestral Omnivorous Diet for Bone Health
A disease-fighting diet is one that contains the entire spectrum of nutrients the human body needs. Diets that exclude ancestral food groups – notoriously meat – set us up for nutrient deficiencies that lead to the degeneration of our health.
And of course, the nutrients listed above are not the only ones found in animal products that help to build and strengthen bone. In my next article, I’ll cover how zinc, protein, omega-3 fatty acids and other critical vitamins and minerals help to reduce your risk of fractures – and therefore increase your ability to enjoy healthy longevity.
For more health and nutrition articles from Kelley Herring, see our Discover Blog.
Ed Note: Need some kitchen inspiration? Grab Kelley’s free guide – Instant Pot Keto Dinners – made exclusively with Paleo-and-Keto ingredients, for quick and delicious meals that taste just as good – of not better – than your restaurant favorites. Get your free guide here.
- Adachi JD, Adami S, Gehlbach S, Anderson FA Jr, Boonen S, Chapurlat RD, Compston JE, Cooper C, Delmas P, Díez-Pérez A, Greenspan SL, Hooven FH, LaCroix AZ, Lindsay R, Netelenbos JC, Wu O, Pfeilschifter J, Roux C, Saag KG, Sambrook PN, Silverman S, Siris ES, Nika G, Watts NB; GLOW Investigators. Impact of prevalent fractures on quality of life: baseline results from the global longitudinal study of osteoporosis in women. Mayo Clin Proc. 2010
- Cooper C. The crippling consequences of fractures and their impact on quality of life. Am J Med. 1997 Aug 18;103(2A):12S-17S; discussion 17S-19S. doi: 10.1016/s0002-9343(97)90022-x. PMID: 9302893.
- Caliri A, De Filippis L, Bagnato GL, Bagnato GF. Osteoporotic fractures: mortality and quality of life. Panminerva Med. 2007 Mar;49(1):21-7. PMID: 17468730.
- Tammy Y. N. Tong, Paul N. Appleby, Miranda E. G. Armstrong, Georgina K. Fensom, Anika Knuppel, Keren Papier, Aurora Perez-Cornago, Ruth C. Travis, Timothy J. Key. Vegetarian and vegan diets and risks of total and site-specific fractures: results from the prospective EPIC-Oxford study. BMC Medicine, 2020; 18 (1) DOI: 10.1186/s12916-020-01815-3
- Jackson RD, LaCroix AZ, Gass M, Wallace RB, Robbins J, Lewis CE, Bassford T, Beresford SA, Black HR, Blanchette P et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med 2006;354:669–83.
- Baran D, Sorensen A, Grimes J, Lew R, Karellas A, Johnson B, Roche J. Dietary modification with dairy products for preventing vertebral bone loss in premenopausal women: a three-year prospective study. J Clin Endocrinol Metab 1990;70:264–70.
- Heaney RP, Rafferty K, Dowell MS. Effect of yogurt on a urinary marker of bone resorption in postmenopausal women. J Am Diet Assoc 2002;102:1672–4.
- Tucker KL. Vegetarian diets and bone status. Am J Clin Nutr. 2014 Jul;100 Suppl 1:329S-35S. doi: 10.3945/ajcn.113.071621. Epub 2014 Jun 4. PMID: 24898237.
- Malde MK, Graff IE, Siljander-Rasi H, Venäläinen E, Julshamn K, Pedersen JI, Valaja J. Fish bones–a highly available calcium source for growing pigs. J Anim Physiol Anim Nutr (Berl). 2010 Oct;94(5):e66-76. doi: 10.1111/j.1439-0396.2009.00979.x. PMID: 20487094.
- Food and Nutrition Board, Institute of Medicine. Dietary References Intakes for calcium and vitamin D. Committee to Review Dietary Reference Intakes for Vitamin D and Calcium. Washington, DC: National Academies Press, 2011.
- Jasinghe VJ, Perera CO. Distribution of ergosterol in different tissues of mushrooms and its effect on the conversion of ergosterol to vitamin D2 by UV irradiation. Food Chem 2005;92:541–6.
- van Wijngaarden JP, Doets EL, Szczecinska A, Souverein OW, Duffy ME, Dullemeijer C, Cavelaars AE, Pietruszka B, Van’t Veer P, Brzozowska A et al. Vitamin B12, folate, homocysteine, and bone health in adults and elderly people: a systematic review with meta-analyses. J Nutr Metab 2013;2013:486186.
- Tucker KL, Hannan MT, Qiao N, Jacques PF, Selhub J, Cupples LA, Kiel DP. Low plasma vitamin B12 is associated with lower BMD: the Framingham Osteoporosis Study. J Bone Miner Res 2005;20:152–8.
- Morris MS, Jacques PF, Selhub J. Relation between homocysteine and B-vitamin status indicators and bone mineral density in older Americans. Bone 2005;37:234–42.
- honukshe-Rutten RA, Lips M, de Jong N, Chin APMJ, Hiddink GJ, van Dusseldorp M, De Groot LC, van Staveren WA. Vitamin B-12 status is associated with bone mineral content and bone mineral density in frail elderly women but not in men. J Nutr 2003;133:801–7.
- McLean RR, Jacques PF, Selhub J, Tucker KL, Samelson EJ, Broe KE, Hannan MT, Cupples LA, Kiel DP. Homocysteine as a predictive factor for hip fracture in older persons. N Engl J Med 2004;350:2042–9.
- Kaplan P, Tatarkova Z, Sivonova MK, Racay P, Lehotsky J. Homocysteine and Mitochondria in Cardiovascular and Cerebrovascular Systems. Int J Mol Sci. 2020 Oct 18;21(20):7698. doi: 10.3390/ijms21207698. PMID: 33080955; PMCID: PMC7589705.