View Full Version : calcium, osteo and vegan outreach

Mar 5th, 2007, 03:42 AM
A friend sent me this vegan outreach url: http://www.veganhealth.org/articles/bones which states that an EPIC-Oxford study recruited 57,000 participants, including over 1,000 vegans and almost 10,000 lacto-ovo vegetarians, from 1993 to 2000. They were asked to fill out a questionnaire to measure what they ate. About 5 years after entering the study, they were sent a follow-up questionnaire asking if they had suffered any bone fractures.

After adjusting for age alone, the vegans had a 37% higher fracture rate than meat-eaters. After adjusting for age, smoking, alcohol consumption, body mass, physical activity, marital status, and births and hormone replacement therapy for women, the vegans still had a 30% higher fracture rate.

There's a lot more, but just the above is rather disturbing, not because I believe the findings, but because it comes from vegan outreach, and wonder where they are coming from!

Mar 5th, 2007, 07:51 AM
There's a lot more, but just the above is rather disturbing, not because I believe the findings, but because it comes from vegan outreach, and wonder where they are coming from!

I think veganoutreach.com is brilliant - at showing how totally unbalanced information someone who claims to promote veganism can provide. In what seems like a neurotic obsession with not being accused for exaggerating the positive health aspects of going vegan - they have have ended with a totally exaggerated focus on 'what can go wrong' if you eat vegan.

What is balanced info? How can we inform vegans and non-vegans about nutrition? Of course a site dedicated to vegan nutrition shall not hold back any studies that questions if vegans get the nutrients they need. It should not in any way hide that non-vegans normally have higher levels of eg. B12 than vegans. This is important information, and very few people, if any, have perfect levels of all nutrients in their bloodstream. But it should be balanced, and both discuss all the reasons why we may be low in certain nutrients, and also show info about all the nutrients non-vegans normally are low or deficient in. If not, meat eaters reading this info will falsely have their false ideas that 'vegan is difficult, eating animal products is easy'. That's what most people believe, and if they see a vegan presenting info in a similar way, they must be totally convinced that their parents/teachers/non-vegan friends are right.

Balanced information about vegan/non-vegan nutrition need to contain both information about what nutrients non-vegans normally are deficient in and what nutrients vegans normally are deficient in. It should also contain information about nutrients that vegans or non-vegans may have to high levels of, and try to be as neutral as possible and not color the facts at all. If we fail to inform about fiber, phytochemicals, vitamin C, antioxidants etc., and go blind on the nutrients vegans may be low in (and forget the nutrients non-vegans normally are low in), we provide unbalanced info. We actually do the same stuff anti-vegans and non-vegans do: we give the false impression that meat eaters are healthier than vegans, even without trying, or that vegans, unlike non-vegans, need to take supplements to get the nutrients the need, while meat eaters can just eat what they eat and not worry.

Vegananhealth.org is extremely far from this balance, and are more or less obsessed with what may go wrong if you eat vegan. They should IMO inform equally much about 'what may go wrong' if you go vegan, and 'what may go wrong' if you don't. If they focus only on 'what may go wrong' if you eat vegan, and not on balancing this out with all the health vegan benefits and info about the nutrients non-vegans normally are deficient in, their vistors (who may be non-vegan doctors, vegan newbies, journalists) will only get the impression that if you go vegan, you really need to worry about your health, B12, vitamin D, calcium etc., but if you don't, you are fine.

In my opinion, that balanced need to be reflected not only in WHAT they write, but in how much they write. We know that non-vegan parents, journalists, health personal generally know very little about veganism or vegan nutrition, and they deserve and probably expect to find out more about the difference between vegan and non-vegan nutrition vegan visiting a site called Vegan Health, and at least that the information provided there contains the pro-vegan facts that non-vegans cannot provide.

veganoutreach.org is also a very special case - we've had several spammers trying to promote that to such a degree (posting links to the several times a day) that we had to just stop it. I don't know if they are paying people to do this, but I saw the same people post identical messages on other forums as well, and these people (maybe it was only one person, using different user names/IP addresses?) almost exclusively posted links to the three main sites run by the main person behind veganoutreach. Take a you look at their homepage, it's so unbalanced, so full of negative focus, so little enthusiastic about spreading the nutrient information vegans should spread. If/when I have time to comment their 69 page long collection of B12 stuff, I'll do it - it's basically a scandal, not only due to all the information that's not there, but due to the anti-vegan focus/bias. There seem to be a kind of collective lack of self confidence among certain people who inform about vegan nutrition. If you discuss the B12 levels in an egg, they won't question how reliable a B12 source or is or if it has been proven that it can lower the MMA and homocysteine levels, and if you talk about B12 in fortified food or multivitamins, they automatically praise that B12 as useful and bio-available, but if there's a new study showing that B12 is found in a plant, they more or less automatically are negative, and assume that it's not usable and remind you about all the tests that hasn't been done yet that confirms that the info from that original test is correct. We should not be pro-vegan fanatics, but we should let go of our pre-programmed mind that has been unconsciously trained by schools and parents etc. to assume that without animal products we can't possibly contain as many nutrients (or as healthy levels of these) as we can if we don't eat animal products. Look here.

Don't get me wrong, I don't agree with Jack Norris' opponents (http://www.present-truth.org/Health%20Library/Silence-Lambs.htm) either, who seem to claim that vegans as a rule never need B12. All I suggest is that we should seek the truth, and avoid any bias in any direction: everything else would only be fooling ourselves. Unfortunately, veganhealth.org is biased, and for some reason they often seem to be biased in the same way anti-vegans are biased, with a lot more questions asked about the healthiness of vegan food than questions about non-vegan food. Too bad, because there's a lot of work put into that site, and it could have been a great source of balanced information for vegans and non-vegans who want to learn more.

So much about veganhealh.org. What I meant to write, Eve, when asking it where they are coming from, was only to say that this is the kind of info they seem to love to spread, and that you should expect similar focus from them in the future. Knowing the kind of spammers they have working for them on other sites, it's kind of absurd.

And before someone suggest that that I'm biased too, that I have a strong anti-veganoutreach/anti-veganhealth.org bias... you are right! :)

As you'll see in the link I posted above, Jack Norris have been talking about vegans and bone factions for years. Without being overly problem-oriented, we know that of course vegans need to get their calcium, vitamin D etc. from somewhere - and like everybody else, we will become deficient in the nutrients we don't get enough of, and like everybody else, if we become deficient, this may mean health issues we could have avoided. More about that and calcium/osteo later!

Mar 5th, 2007, 04:41 PM
Good post Korn.

Eve, As Korn said, the info presented is unbalanced. The truth is however far from what the research claims or fabricated. The American Journal of Clinical Nutrition funded a study by Deborah Sellmeyer (M.D) which conducted a thorough study on the diets of over a 1000 women. The idea of the research was to study the effects on calcium due to variation in diets. The result of this research was a publication titled "Animal Protien increases bone loss".

The study clearly indicated women with high animal-to-vegetable protien ratio experienced increased bone loss and hip-fracture. Animal protiens promote osteoclastic activity and inhibits osteoblast (bone synthesis and re-structuring) activity. Women consuming more animal protien experienced four times the bone loss compared to the ones who avoided animal protien.

This research is reliable because it has been funded and attested by National Institutes of Health (US). Although the research was based on women's diet, I don't see how it is any different for men.

Mar 6th, 2007, 08:27 AM
Thanks Korn and Kiran, but actually my visits to veganoutreach are extremely rare as I am sceptical about that organisation. When a friend brought my attention to the article, I was keen for Korn's comments. Actually I replied to my friend that I'm not impressed with veganoutreach, and she sent the article to Dr McDougall for his comments. Not received yet.

Mar 6th, 2007, 10:02 AM
I was keen for Korn's comments I'll post more as soon as I've got time. We need a lot more sunlight ( = vitamin D, which also should mean more calcium, because calcium absorption in linked to vitamin D) than people living normal lives (working indoors when the sun is shining) get, living too far from Equator etc). The title of the article suggests that a new study answers questions about the vegan diet, calcium, and bone health, but IMO the article raises more questions than it answers. It's interesting to see that the dietary reference intake (DRI) for calcium is 1000 mcg daily for people between 18 and 50, but that among the studied subjects who got 525 mg of calcium a day (only 55% of the vegans compared to about 95% of the other diet groups), vegans had the same fracture rates as the other diet groups. I wish I could have written a short comment, but there are so many things to comment there that it will take some time. There is confusion about the relationship between calcium and vitamin D, about whether people on a vegan diet need as much of certain nutrients as non-vegans, and in that article, there's also confusion about stuff like what 'natural sources' are: "The only significant, natural sources of vitamin D in foods are fatty fish (e.g. cod liver oil), eggs (if chickens have been fed vitamin D), and possibly some wild mushrooms". In good tradition, they add a 'possibly' whenever they can when talking about plants (more about that later), but how can an egg from a chicken fed vitamin D be a 'significant, natural source'? Adding supplements/fortification is by everybody else used as an example of non-natural sources.

Kiran, there are several studies on high protein intake from plant or animal sources and bone health (here's one: Dietary Animal and Plant Protein and Human Bone Health: A Whole Foods Approach (http://jn.nutrition.org/cgi/content/full/133/3/862S)). What does Deborah Sellmeyer / The American Journal of Clinical Nutrition said about calcium and bone health?

Thanks for mentioning this article, Eve. It says both says that "There is no reason why a vegan cannot get every bit as much calcium in their diet as the typical meat or dairy eater," and that "among the studied subjects who got 525 mg of calcium a day (circa half the DRI), vegans had the same fracture rates as the other diet groups", but it's written in a way that gives the impression that VO knows something that those exposed to the normal 'vegan propaganada' delivered by other vegans doesn't inform about.

Getting enough calcium from food isn't a problem - but the writer both takes calcium fortified food and daily calcium supplements. It would be interesting to hear their comments on this (http://www.sciencedaily.com/releases/2006/09/060915202522.htm) study.

More later.

Mar 6th, 2007, 02:53 PM
What does Deborah Sellmeyer / The American Journal of Clinical Nutrition said about calcium and bone health?Korn,

It actually surprises me that the National institution of health was happy to accept the outcome of Deborah's research. Usually such government organisations don't support facts that go against the meat or dairy industry. Perhaps Deborah's research was so intensive that they could not ridicule it.

If you interested, the full paper is here...:)
http://www.ajcn.org/cgi/reprint/73/1/118.pdf (http://www.ajcn.org/cgi/reprint/73/1/118.pdf)

A few highlights from the paper...

Animal foods provide predominantly acid precursors, whereas protein in vegetable foods is accompanied by base precursors not found in animal foods. Imbalance between dietary acid and base precursors leads to a
chronic net dietary acid load that may have adverse consequences on bone.

Diets that are rich in animal foods and low in vegetable foods, typical of industrialized countries, lead to a dietary net acid load that has a negative effect on calcium balance

In age- and weight-adjusted analyses, the relative risk (RR) of hip fracture was significantly higher in women with a high intake of animal protein than in those with a low intake (RR = 2.7, P = 0.04). In contrast, women with a high intake of vegetable protein had an RR of hip fracture of 0.30 (P = 0.03).

This suggests that increases in vegetable protein intake and decreases in animal protein intake may decrease bone loss and the risk of hip fracture.
This is as scientific as it gets. The publication clearly explains (with adequate references and evidences) why animal protien intake weakens the bones.

Mar 6th, 2007, 08:07 PM
I'll have a look, Kiran - thanks. It looks like a document mainly focused on bone loss and protein, the link Eve posted is about bone fracture and calcium, but I'm sure there's relevant info there.

Mar 6th, 2007, 09:42 PM
Korn, the publication talks about the animal based protien and its relationship to calcium balances in the body. Deborah highlights that animal protien negatively effects calcium and causes weak bones (and hence fracture).

Mar 6th, 2007, 11:08 PM
I'm afraid I haven't read those links yet so I might be about to post something pointless (me?) but I thought the biggest thing we could do to prevent osteoporosis was to do weight bearing excercise, ie. walk lots!

Mar 12th, 2007, 11:38 AM
The truth is however far from what the research claims or fabricated. The American Journal of Clinical Nutrition funded a study by Deborah Sellmeyer (M.D) which conducted a thorough study on the diets of over a 1000 women. The idea of the research was to study the effects on calcium due to variation in diets. The result of this research was a publication titled "Animal Protien increases bone loss".

I think we should be careful - when looking at two different studies - to claim that the truth is very far from what the research in one of the studies claims, because another study shows info that may conflict with it's conclusions. Looking at two studies and choosing to believe in the study we hope is the correct may be tempting, but not very scientific...

If we look at both these studies, they aren't necessarily in conflict with each other.

First, the study cited by VO: it concludes that vegans had a 30% higher fracture rate than meat eaters, but also that among the studied subjects who got 525 mg of calcium a day (circa half the US DRI, or 85% of the UK RDI), vegans had the same fracture rates as the other diet groups. To have an opinion about the numbers a study as such may not have a lot of value, but having disagreeing in how a study is interpreted - or how it is set up - can sometimes be very interesting. Let's assume that the study is right, and that vegans with less that circa half the recommended daily intake of calcium have similar fracture rates as people in other diet groups. This is kind of interesting, because one would maybe assume that vegans with lower calcium intake than 1000 mcg would have higher fracture rates than the average population. Maybe the reason vegans consuming only half the calcium that is generally recommended don't have higher fracture rates than meat eaters (when ) is exactly what the other study shows, namely that we don't consume animal proteins?

If you look at that article again, it refers to different studies with conclusions that doesn't match each other at all, eg. when discussing if it's lack of calcium or lack of vitamin D that's the most important bone fracture cause (more about this later), and there are similar disagreements regarding the effect (animals vs. non-animal based) protein, homocysteine, B12 etc. have on bone fracture. One example:

Another example: It has been found that there is a link between homocysteine levels and various health conditions, including bone fracture. A simplistic way to look at this connection would be to assume that since too hight homocystiene levels are liked with bone fracture, and B12 is known to lower homocysteine levels, taking B12 supplements may solve the problem. A study (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=15883631) from June 2005 on 1267 people concluded that high homocysteine and low vitamin B12 concentrations were significantly associated with increased fracture risk.

Homocysteine leves are influenced by several factors, B12 and folate being two of the most known. Five months after the study showing a link between B12/homocysteine and bone fracture risk was published, another study was published concluding that there were "no independent association was found for serum vitamin B12" and bone fracture, but that a folate level (which also can cause high homocystiene levels), and not the homocystiene level itself, should be seen as the main cause for bone fracture in elderly persons: "Low serum folate is responsible for the association between homocysteine and risk of osteoporotic fracture in elderly persons (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16339334)" A new study was published in January this year, concluding that total elevated homocysteine and low folate levels were associated with reduced bone mineral density in women but not in men. (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=16401815)

Finally, a month ago, a new report was posted on PubMed concluding that "high levels of homocysteine and low levels of folate predicted fracture, whereas vitamin B12 and genotypes were not related to fracture risk" (http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17295607&itool=iconabstr&query_hl=4&itool=pubmed_DocSum)

I admit that I'm a little obsessed with B12, but in this context, it's relevant. :) If it is correct that bone fracture is associated with folate, and not B12, and that he relative risk of hip fracture is higher in women with a high intake of animal protein than in those with a low intake, and that vegans (unless they consume at least 55% of the US RDI or 84% of the UK calcium RDI) have a 30% higher fracture rate than non-vegans, vegans should pay attention to these facts. Or: the 45% of all the vegans in the study cited in post#1 in this thread, because they absorb too little calcium (if these numbers are reliable) - again: if the calcium is the reason for their higher degree of bone fracture.

Calcium is important for B12 absorption, and if it's correct that 45% of the vegan subjects in the study above (as opposed to only 5% of the non-vegan subjects) had calcium intake below 525mcg daily, this could be one of several reasons that B12 is one of few the nutrients vegans normally have lower levels of than non-vegans.

Here are some links about vegan calcium sources:
Calcium in the Vegan Diet (http://www.vrg.org/nutrition/calcium.htm)
Good Vegan Calcium Sources (http://pages.interlog.com/~john13/recipes/calcium.htm)
Vegan Sources of Calcium (http://www.vegansociety.com/html/food/nutrition/calcium.php)

Here are some links about bone health in vegans:
Beyond Dairy and Calcium: The Truth About Diet and Bone Health (http://www.vegansociety.com/phpws/index.php?module=pagemaster&PAGE_user_op=view_page&PAGE_id=6&MMN_p):

Calcium is a very good thing, but increasing calcium intake from 500

mg per day to 1500 mg per day by taking supplements will add less than

90 mg per day to the calcium retained by most adults, and less than 50

mg per day for the 10 per cent with the lowest calcium absorption, who

are at particular risk of osteoporosis.

Other aspects of diet are equally significant: 10 g of SALT per day will

SUBTRACT about 70 mg per day from retained calcium by increasing calcium

losses in urine whereas 4000 mg of extra POTASSIUM from a diet rich in

vegetables, fruits and other unrefined plant foods will ADD 60 mg per

day to retained calcium by reducing calcium losses. RELYING ON CALCIUM



Preventing Osteoporosis: Building Strong Bones Over a Lifetime (http://www.vrg.org/journal/vj2005issue2/vj2005issue2bones.htm)

Women are at much greater risk for osteoporosis than men because women start out with less bone and lose bone mass more quickly, particularly in the years immediately after menopause. Women between the ages of 20 and 29 have about 76 percent the bone matter of men; by their 70s, this decreases to about 60 percent.1 Thus, when women age and start losing bone mass, they develop very fragile bones. Genetics also appears to play a role in that osteoporosis runs in families.

Sorting through the Calcium Myths (http://www.vegsource.com/articles/calcium_update.htm):

The average daily calcium intake for South African blacks is 196 mg whereas the daily calcium intake for African-Americans is more than 1,000 mg. Yet the hip fracture rate for African-Americans compared to South African blacks is NINE TIMES GREATER! [Calif Tissue Int 1992;50:14-18] And those countries with the highest calcium consumption turn out to be the same ones with the highest rates of osteoporosis.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1440-172X.2006.00580.x?journalCode=ijn :

The purpose of this review is to examine the current literature regarding calcium and Vitamin D deficiencies in vegan diets and the possible relationship to low bone mineral density and incidence for fracture. Prominent databases were searched for original research publications providing data capable of answering these questions: (i) Do vegans have lower-than-recommended levels of calcium/Vitamin D? (ii) Do vegans have lower bone mineral density than their non-vegan counterparts? (iii) Are vegans at a greater risk for fractures than non-vegans? The findings gathered consistently support the hypothesis that vegans do have lower bone mineral density than their non-vegan counterparts. However, the evidence regarding calcium, Vitamin D and fracture incidence is inconclusive. More research is needed to definitively answer these questions and to address the effects of such deficiencies on the medical and socioeconomic aspects of life.

Worried about osteoporosis? (http://www.vegansociety.com/phpws/index.php?module=pagemaster&PAGE_user_op=view_page&PAGE_id=27&MMN_position=36:22)

A vegan diet including plenty of fruit and vegetables provides abundant
bone-protecting potassium and vitamin K along with good amounts of
calcium, particularly if green leafy vegetables or calcium-set tofu are
used regularly. It also provides abundant folate, carotenoids and other
protective antioxidants which may reduce risk of heart disease and
cancers. Levels of saturated fat are healthfully low and there is no
cholesterol whatever. The advantages of the green stuff over the white
stuff are scientifically beyond dispute.


Vegans obtain their calcium from vegetation, just like herbivorous animals such as cattle and horses. Good sources include vegetables such as broccoli, Brussels sprouts, collards and kale, dried figs and raisins, all types of beans and peas (especially tofu prepared with calcium sulphate), whole grains, nuts and seeds. The element boron, found almost exclusively in plant foods, also helps the body to retain calcium, which is particularly well absorbed from low-oxalate vegetables such as kale (only 20-30% of the calcium in the average diet is absorbed by the body). Dairy products are rich in calcium, but also contain unhealthy amounts of fat and dietary cholesterol, and can cause allergies, lactose intolerance and juvenile diabetes. They contain no fibre and little iron. Plant foods do not have these disadvantages. Thus, calcium-fortified foods are not essential for vegans.

Research has shown that a high-calcium diet is no guarantee against osteoporosis. Indeed, Eskimos have the highest incidence of osteoporosis in the world despite consuming a massive 2000 mg of calcium per day. The typical Westerner consumes 1000-1500 mg of calcium daily, compared to the 500 mg per day consumed by the inhabitants of developing countries in Africa and Asia where the intake of dairy products is much lower and the incidence of osteoporosis is less than 20 per cent of that in the West. The reason for this is that excess animal protein leaches calcium from the bones. Salt, coffee and alcohol also limit calcium absorption. An ecological study found a strong positive association between animal protein intake and hip fracture rates in women. Thus diets which are low in animal protein, such as those of rural Africa and Asia, may be in calcium balance despite a low calcium intake, whereas high protein diets may lead to a net loss of calcium from the body despite a high dietary intake. Osteoporosis is, therefore, a disease of calcium loss rather than one of calcium lack. Studies of vegetarians suggest that their loss of bone in later life is lower than that of age-matched non-vegetarians. Nutrition aside, weight-bearing exercise is important in promoting bone strength.

Dr David Ryde

Hip Fracture Rates and Vegan Calcium Needs (http://vegrd.vegan.com/pages/article.php?id=462)

It’s easy to see that you can’t look at hip fracture rates in different cultures and make a conclusion about diet. There are too many other factors at work here. So it shouldn’t be too much of a surprise to learn that, in some countries where hip fracture rates are low, people still have considerable osteoporosis, in their spine for example.

Therefore, it just is not possible to draw any conclusions about bone health based on comparisons of hip fracture rates. It is also impossible to determine vegan calcium needs based on these hip fracture observations.

Sources of Calcium: Plant-based (vegan) vs. animal sources (http://www.soystache.com/calcium.htm) <––– Contains other links...

Diet and bone health (http://www.vegansociety.com/downloads/dietandbone.pdf) <––– pdf-file from The Vegan Society.

Protecting Your Bones (http://www.pcrm.org/health/Preventive_Medicine/strong_bones.html):

The bone-thinning condition called osteoporosis can lead to small and not-so-small fractures. Although many people think of calcium in the diet as good protection for their bones, this is not at all the whole story. In fact, in a 12-year Harvard study of 78,000 women, those who drank milk three times a day actually broke more bones than women who rarely drank milk.1 Similarly, a 1994 study of elderly men and women in Sydney, Australia, showed that higher dairy product consumption was associated with increased fracture risk. Those with the highest dairy product consumption had approximately double the risk of hip fracture compared to those with the lowest consumption.2

To protect your bones you do need calcium in your diet, but you also need to keep calcium in your bones.