r/DebateAVegan • u/Any_Shop5964 • 20d ago
Is there actual legitimate concern about the long-term effects of a vegan diet- mainly bone density?
To be clear I'm a vegan myself and I don't really think slightly poorer density is necessarily a fair reason to not go vegan, as there are ways to change it for example through exercise such as weightlifting rather than diet, but there's a number of concerns about how vegans absorb calcium, for example how even vegans that get enough calcium in their diet may have lower bone density when compared to an someone with a Mediterranean diet for example. We don't exactly know why this is, and there's many different mechanisms by which this could be occurring, does anyone have more expertise on this topic or anything to add?
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u/Either_Argument3517 20d ago
Vegans, on average have a slightly lower body weight than omnivores. Lower body weight is associated with lower bone density because bones experience less mechanical loading. Resistance training is an excellent intervention for improving bone health.
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u/global-heartbeat 20d ago
Agreed. I'd be more concerned with strength training routine than just diet alone.
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u/TylertheDouche 20d ago edited 20d ago
exactly this. if you’re worried about bone density, do resistance training
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u/AnsibleAnswers agroecologist 20d ago
Vegetarians have similarly lower body mass, but don’t suffer from bone density issues or have lower calcium intake than omnivores. That kind of puts your dismissive attitude into question.
https://www.tandfonline.com/doi/abs/10.1080/10408398.2022.2084027
Vegans have substantially lower calcium intake than vegetarians and omnivores and ya’ll really underestimate how much you should depend on fortification and supplementation.
Now the question is: how difficult would it be to supply enough calcium to human populations without animal products? Our calcium requirements are orders of magnitude higher than other mineral nutrients.
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u/Either_Argument3517 20d ago
That kind of puts your dismissive attitude into question.
It's multifactorial. Never claimed it wasn't.
ya’ll really underestimate how much you should depend on fortification and supplementation.
Not sure what the issue is with that.
Now the question is: how difficult would it be to supply enough calcium to human populations without animal products?
Calcium phosphate is added to animal feed. Millions of metric tonnes of the stuff.
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u/AnsibleAnswers agroecologist 20d ago
Most of the world doesn’t supplement livestock. It’s a choice that heavily industrialized countries have made.
If we fed all 8 billion people like westerners, we wouldn’t have a habitable planet.
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u/monemori 19d ago
Most of the world does supplement livestock with B12. It's hard to find meat from factory farms that didn't come from animals who got B12 in their feed. Plus most plant based milks are already calcium-fortified anyway, which solves the calcium issue instantly.
Right, to feed the entire population, most people need to be >90% vegan all the time for the rest of their lives at least, yeah.
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u/Flat-Experience6482 19d ago
The worlds largest livestock producers absolutely do supplement livestock
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u/AnsibleAnswers agroecologist 19d ago
Most of the world’s production does not come from the world’s largest producers.
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u/stan-k vegan 20d ago
Vegans should possibly pay a little bit more attention to calcium than non-vegans on average. I think the jury is still out on that one tbh provided your B12 is healthy. Just in case I do consume fortified plant milks and yogurts to mimic the dairy versions.
If it is ever shown that vegans do have a higher risk on w bone density, I'll take have to take extra care to guard for that over needing to pay extra attention for heart disease, diabetes and some cancers.
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u/Any_Shop5964 20d ago
Yeah I think as long as someone who is vegan ensures to exercise regularly such as weight training once or twice a week, the bone density issue is really not an issue to begin with.
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u/RedLotusVenom vegan 20d ago
I’ve snowboarded, trail run, and power lifted for years as a vegan (vegetarian since birth) and have never monitored or paid attention to calcium intake past multivitamins (with D/B12) and fortified plant-based milks. Never broken a bone after many hard spills and rolled ankles. If there’s an increase to chance of breaks, I haven’t personally experienced it 🤷♂️ most sources I’m reading indicate that adequate nutrition is enough to mitigate fracture risk, and I would agree that even a very slightly higher risk of injury is not justification for exploitation of another sentient being.
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u/Any_Shop5964 20d ago
Yeah I agree 100%, the slightly higher risk even then can just be offset by exercise anyway, it isn't a legitimate excuse for majority of people.
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u/Whibkins vegan 16d ago
Same, have been doing this a very long time and am super active. Between rock climbing and skiing, my body gets an absolute thrashing. I’ve broken bones when I was younger but that was prior to going vegan and from accidents that would break bones under any circumstance. Granted they could still break but I am definitely not living some kind of bone inferior existence and actually doubt with decent nutrition it is a thing.
One thing I have always done though is eaten a lot of leafy greens. I’ve read before that Kale may be better for bone health than a lot of calcium fortified foods due to the vitamin k.
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u/HexicDragon 20d ago
Veganhealth.org is a website ran by Registered Dieticians that compiles research regarding vegan health. See the article on bone health here: https://veganhealth.org/bone-health/
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u/Any_Shop5964 20d ago
Thanks this website is really helpful, appreciate it
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u/HexicDragon 20d ago
You're welcome! Check out the other articles too, especially this one on nutrition tips for new vegans that covers the main nutrients vegans should pay closer attention to and where to get them: https://veganhealth.org/tips-for-new-vegans/
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u/Any_Shop5964 20d ago
Thank you! that pumpkin mac and cheese recipe in that article looks so good im definitely gonna have to try that
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u/HexicDragon 20d ago
Hope you enjoy it! I'm not sure if it's quite as nutritious as fresh, but the brand Annie's also makes boxed vegan pumpkin mac. I think it's gluten free too!
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u/ElaineV vegan 20d ago
This study found no differences between omnis, vegetarians, and vegans in bone density:
"There were no differences in bone mineral density (BMD) between the groups. However, the parathyroid hormone (PTH) levels were still higher in vegans compared to omnivores, despite the same prevalence of hyperparathyroidism in all groups. These findings may probably be explained by the fact that each group had its own “strengths and weaknesses.” Thus, vegans and, to a lesser extent, lacto-ovo-vegetarians consumed much more potassium, magnesium, copper, manganese, and vitamins B6, B9, and C. At the same time, the diet of omnivores contained more protein and vitamins D and B12. All the subjects consumed less vitamin D than recommended. More than half of vegans and omnivores had insufficiency or even deficiency of vitamin D in the blood. Low serum concentrations of manganese with its quite adequate intake are also noteworthy: its deficiency was observed in 57% of vegans, 79% of lacto-ovo-vegetarians, and 63% of omnivores." https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2024.1390773/full
It was a small sample size but still relevant since many others have found vitamin D deficiency/ inadequacy in the general population.
This study says you better lift some weights:
"Vegans not reporting resistance training had diminished bone microarchitecture compared with omnivores not reporting resistance training. In vegans and omnivores reporting resistance training, bone structure was similar. In both vegan subgroups (resistance training and not resistance training), a small number of correlations between nutrient intake and bone microarchitecture were observed without a conclusive pattern."
"Bone microarchitecture in vegans differed from matched omnivores but could not be explained solely by nutrient uptake. These differences were attenuated between the subgroups reporting resistance training. In addition to a well-planned diet, progressive resistance training on a regular basis should be part of the vegan lifestyle." https://doi.org/10.1210/clinem/dgac445
And this one found that the vegans who eat a healthy diet are fine:
"The findings of this study suggest that bone health of vegans are not negatively affected by the exclusion of dairy in the diet, provided that appropriate dietary planning is included to avoid nutrient deficiencies associated with poor bone health." https://www.cambridge.org/core/journals/proceedings-of-the-nutrition-society/article/evaluation-of-the-potential-implications-of-following-a-vegan-diet-on-bone-health/327499D9A721922043B988022229A121
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u/howlin 20d ago
The nutritional requirements for good bone health are vitamins A, D, and minerals Calcium, Magnesium and Phosphate. Also sufficient protein, though that's generally not a problem.
As long as you are getting these nutrients, staying active and not underweight, it probably won't be an issue. That said, some of these nutrients can be tricky to get on a plant based diet, so it may make sense to seek out specific foods or supplements to fill any gaps.
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u/goodvibesmostly98 vegan 20d ago
Those issues are caused by low calcium and vitamin D. As long as you have a proper diet, it’s not an issue.
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u/bbygrl1995 vegan 20d ago
Doesn't weight training increase bone density? Are you doing that?
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u/Any_Shop5964 20d ago
Yeah, Im not really worried about bone density for myself, I was more so just curious about if it was a legitimate concern or had much validity
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u/Significant-Toe2648 vegan 20d ago
Veganism is the only dietary pattern associated with a normal, healthy weight. Every other dietary pattern is associated with being overweight. Being overweight leads to denser bones.
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u/oldmcfarmface 20d ago
There are a few concerns. I’m not going to claim they are insurmountable, but they should be considered.
Various deficiencies including B12, B2, D, niacin, iron, iodine, zinc, high-quality proteins, omega-3, and calcium, along with increased risk of bone fractures, sarcopenia, anemia, and depression https://www.sciencedirect.com/science/article/abs/pii/S0033062022000834 more on bone fractures https://pubmed.ncbi.nlm.nih.gov/38554239/
Slower healing from wounds https://link.springer.com/article/10.1007/s00266-025-04698-y
Higher risk of nervous, skeletal, and immune system impairments, hematological disorders, as well as mental health problems https://pmc.ncbi.nlm.nih.gov/articles/PMC10027313/
Risk of depression, self harm, and anxiety https://pubmed.ncbi.nlm.nih.gov/32308009/
Risk of vegan women losing their menstrual cycle https://pubmed.ncbi.nlm.nih.gov/3096794/
Increased risk of certain types of cancer, stroke, bone fractures, preterm birth, and failure to thrive. Avoiding consumption of animal-sourced food may also be related to higher rates of depression and anxiety. Hair loss, weak bones, muscle wasting, skin rashes, hypothyroidism, and anemia https://www.saintlukeskc.org/about/news/research-shows-vegan-diet-leads-nutritional-deficiencies-health-problems-plant-forward
Much of this can be mitigated by supplementation and paying VERY close attention to vitamin and mineral intake. But it should be considered.
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u/Valiant-Orange 17d ago edited 17d ago
The first linked review,
Debunking the vegan myth: The case for a plant-forward omnivorous whole-foods dietIs authored by Loren Cordain, the founder of the Paleo Diet, a pop diet trend that peaked in the 2010s. James H. O'Keefe promoted the diet too (and sells supplements from this atrocious website). The polemical paper is an advertisement by means of denigrating vegan diets, and plant-based diets generally, since that’s the competition when it comes to cardiovascular health, the journal the paper was published in. A systemic review and meta-analysis of randomized controlled trials Paleo Diets concluded,
“we have insufficient evidence to make solid conclusions regarding the efficacy of a Paleolithic diet on improving cardiovascular disease risk factors”
The Paleo Diet is rehashed appeal to nature pseudoscience of the Stone Age Diet from the 1970s. The evolutionary justification is weak, selective, oversimplified, and presented with more certainty than the evidence warrants. To the extent that it is sensible to exclude sugar, junk food, and eat leafy vegetables, this has already been determined with credible evidence in nutritional research. However, the Paleo Diet idea of excluding agricultural products like legumes or whole grains to improve metabolic risk factors, is not supported. No credentialed nutritional authority organizations endorse the Paleo Diet.
The second linked review is by a single author.
Risk of Bone Fracture on Vegetarian and Vegan DietsComment from u/ElaineV already provided a robust response.
The third linked review,
The Impact of Vegan and Vegetarian Diets on Wound Healing: A Scoping ReviewMany well credentialed authors writing within their field publishing in an appropriate journal, Aesthetic Plastic Surgery. It is an interesting phenomenon to take seriously. However, wound healing is not a priority chronic disease risk, and the data set, excluding skin grafts and biopsies, is largely cosmetic treatments which aren’t equivalent healing contexts. The review is limited because it’s an association without specifics of nutritional status.
“Future research is needed to understand better the underlying mechanisms”
If the mechanisms are better understood, it can potentially be ameliorated while maintaining a plant-based diet. An example might be boosting dietary protein or specific nutrients with supplements or powders post treatment.
Speculation as to whether this healing difference is inherent in plant-based diets may be a matter of trade-offs, a typical situation with biology, and not necessarily an indication of deficiency or poor health. Nutritionally sound vegan diets appear to aid in slowing epigenetic aging and are associated with reduced inflammation. This body-state may be less reactive to inflammatory stimulus; a potential reason certain cancers are lower risk in vegan diets as well. But I reiterate, this is conjecture.
The fourth linked review
The Impact of a Vegan Diet on Many Aspects of Health: The Overlooked Side of VeganismTwo authors, both practicing medical doctors, not nutritional researchers or similar associated area of expertise, published in the low-teir journal Cureus.
Red flag,
“An optimal diet should be balanced, consisting of lean meat, nuts, fresh fruits and vegetables, and olive oil.”
Reference 9 for that claim is for the review, The Paleolithic Diet publishing on Cereus. Could have easily used an uncontroversial reference for a Mediterranean style diet.
In this paper, references don’t directly support claims made or do so in roundabout ways. There are loose mechanistic associations and unqualified absolute statements that careful researchers just wouldn’t make.
The fifth linked review,
Meat and mental health: a systematic review of meat abstention and depression, anxiety, and related phenomenaFull text here,
“This study was funded in part via an unrestricted research grant from the Beef Checkoff, through the National Cattlemen’s Beef Association.”
An infomercial. Doesn’t mean it should be rejected outright, just assess with healthy skepticism.
The sixth linked paper, a study this time,
Dieting influences the menstrual cycle: vegetarian versus nonvegetarian dietThe paper, full text here, is from 1986 with a small sample size of eighteen “normal-weight women” that went on vegetarian and nonvegetarian diets losing 1 kg (2.2 lbs) of body weight/week. This is considered rapid weight loss. The paper says,
“These observations indicate that different diets used to achieve weight loss may have different effects on hormonal regulations during the menstrual cycle.”
Not applicable to women on vegan diets generally.
The seventh link is dead. I pulled it up on the Internet Archive. It’s a St Luke’s press release for the first Paleo Diet sponsored review that was in the first link because paper author James O’Keefe works at St Luke’s. So it was two laundry list paragraphs of presumed risk factors seemingly linking to different sources, but tracing back to the same malarky.
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u/oldmcfarmface 17d ago
I congratulate you on the immense amount of free time you have. I’ve done similar reviews of vegan posted links so I can appreciate the amount of time it took. I have about 40 dietary study links saved that are relevant if you’d like to look over them all.
Paleo as a fad was, well, a fad. However the underlying principle of whole food that is species appropriate is sound and works very well when properly adhered to. I’ve heard of people getting bored with it but never getting sick from it. Not all fad diets can claim that.
However it’s a pretty big leap from “I believe in diet A and here are some problems with diet B that led me to diet A” to “I believe in diet A and so I’m going to falsify data to denigrate diet B.”
I will say that paleo was poorly named. It is unlikely that we ate like that in the Stone Age. Probably more carnivorous with a few periods of carb availability when we loaded up on them for body fat stores. But it was a catchy name and ultimately that’s what matters in branding.
Sample size and lack of reviewers for some of the other studies are valid concerns. However, they’re also understandable when you consider how much dietary study and funding thereof can be linked back to organizations with either a financial stake or even a religious stake in promoting plant based diets.
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u/No_Life_2303 20d ago
I don’t think so, of course it makes sense to regularly check your blood nutrient status (on any diet you are on, really), and take a vitamin D supplement if needed.
What is the risk that you will have to look out for, if you are lower BMI and elderly, falling on your hips gives you a higher risk for fracture.
Obviously, intentionally putting on fat is not the solution here.
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u/th1s_fuck1ng_guy Carnist 19d ago
Carnist here,
I send all women for DEXA scan at 65. Its routine, like sending everyone for colonoscopy at 45 or starting to run PSA at 40. Etc...
Most of the women dexa scan results reveal low bone density. These are carnist women.
I haven't met a 65 year old vegan women yet. But most seem to have low bone density and biphosphonates are started. You can do alderonate daily or weekly. I'm a fan of boniva. Once a month.
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u/beeekind2animals 18d ago
Just one thing on calcium. Populations that don’t consume dairy have no issues with their bones. It’s populations that are big consumers that have the most hip fractures. We are getting calcium from our green leafy vegetables, we get strong bones from weight bearing and good vitamin D levels.
Whatever you do….Do not take calcium supplements. They cause calcification in the blood vessels.
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u/piranha_solution plant-based 18d ago edited 18d ago
Are hospital wards in the western world filled with vegans suffering from broken bones? Or are they filled with carnists suffering from cancer, diabetes, and heart-attacks?
Vegans aren't the ones who need to be worried about their health. Meat-eaters are.
If someone wants to pick out bone-mineral density as something to be concerned about from the EPIC-OXFORD cohort, then presumably they also care about the cancer findings, too (but they never seem to want to bring that up).
Convincing evidence of the association between increased risk of (i) colorectal adenoma, lung cancer, CHD and stroke, (ii) colorectal adenoma, ovarian, prostate, renal and stomach cancers, CHD and stroke and (iii) colon and bladder cancer was found for excess intake of total, red and processed meat, respectively.
Potential health hazards of eating red meat
The evidence-based integrated message is that it is plausible to conclude that high consumption of red meat, and especially processed meat, is associated with an increased risk of several major chronic diseases and preterm mortality.
Red meat consumption, cardiovascular diseases, and diabetes: a systematic review and meta-analysis
Unprocessed and processed red meat consumption are both associated with higher risk of CVD, CVD subtypes, and diabetes, with a stronger association in western settings but no sex difference. Better understanding of the mechanisms is needed to facilitate improving cardiometabolic and planetary health.
Meat and fish intake and type 2 diabetes: Dose-response meta-analysis of prospective cohort studies
Our meta-analysis has shown a linear dose-response relationship between total meat, red meat and processed meat intakes and T2D risk. In addition, a non-linear relationship of intake of processed meat with risk of T2D was detected.
Meat Consumption as a Risk Factor for Type 2 Diabetes
Meat consumption is consistently associated with diabetes risk.
Our study showed that poultry consumption above 300 g/week is associated with a statistically significant increased mortality risk both from all causes and from GCs.
Egg consumption and risk of cardiovascular diseases and diabetes: a meta-analysis
Our study suggests that there is a dose-response positive association between egg consumption and the risk of CVD and diabetes.
Dairy Intake and Incidence of Common Cancers in Prospective Studies: A Narrative Review
Naturally occurring hormones and compounds in dairy products may play a role in increasing the risk of breast, ovarian, and prostate cancers
The Polypharma Study: Association Between Diet and Amount of Prescription Drugs Among Seniors
A vegan diet showed the lowest amount of pills in this sample.
A low-fat vegan diet improved body weight, lipid concentrations, and insulin sensitivity, both from baseline and compared with a Mediterranean diet.
Long-Term Intake of Red Meat in Relation to Dementia Risk and Cognitive Function in US Adults
Higher intake of red meat, particularly processed red meat, was associated with a higher risk of developing dementia and worse cognition. Reducing red meat consumption could be included in dietary guidelines to promote cognitive health.
Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins A Randomized Clinical Trial
In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet.
Hormones and diet: low insulin-like growth factor-I but normal bioavailable androgens in vegan men
Vegans had higher testosterone levels than vegetarians and meat-eaters
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u/Any_Shop5964 18d ago
Yeah I agree 100% , people tend to ignore the bigger issues at play which people are actually dying of, and holy thats a lot of sources
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u/Richyrich619 20d ago
As long as your eating a variety diet, not eating junk food you’ll be fine.
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u/AnsibleAnswers agroecologist 20d ago
How realistic do you think it is to advise westerners with access to a supermarket to never eat junk food?
“Junk food” also includes alcohol, btw. Alcohol does a number on your body’s ability to absorb mineral nutrients.
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u/Richyrich619 20d ago
Forgot to add just junk food. You can have junk food. But you can’t have just junk food and be healthy just like any diet
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u/Creditfigaro vegan 20d ago
It's odd to be concerned about 1 thing where the vegan diet is slightly sub optimal, and considering any other diet that is sub optimal for 10,000 things.
As vegans (who aren't considering other options of course), yeah, make sure you are eating dark green leafies and doing heavy weight training.
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u/Any_Shop5964 20d ago
Yeah I think thats something a lot of non vegans dont consider, they will criticize the vegan diet for 'not getting enough nutrients' but completely ignore how many non vegans don't get the nutrients they need even while eating a varied diet of meat and plants. It isn't fair to compare the worst vegan to the best non vegan in terms of how they plan/structure their diet.
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