There has been a lot of hype about the EPIC-Oxford study and that they show higher bone fractures in vegans. A number of different plant-based doctors and YouTubers have covered the topic with their hypothesis of what may be the cause. Is it nutrient deficiency, or perhaps the study is flawed? One my my favorite vegan / plant-based dieticians, Jack Norris, covered the topic in depth with 6 articles on Vegan Health UK. Without boring you of ALL the details, I wanted to briefly highlight the areas of concern as well as the nutrients that are not likely to be of concern for vegans.
A very quick summary is:
- Resistance training and activities that involve jumping are the most effective ways to maintain and increase bone mass.
- β-carotene was the only nutrient that I believe could explain a significant amount of the higher fracture rate among vegans. This surprised me since many vegan foods are high in β-carotene…but you do have to eat them!
iodine,and selenium (especially in the U.K.) might have played a role in the higher fracture rates, so please make sure you’re aware of these nutrients (see Daily Needs).
Concerning The Paper:
It is an observational study and based on self-reporting in the UK so that is a bit limiting for the study.
The fracture rate was high among vegan women with low body mass index (BMI). Perhaps not eating enough calories, and making themselves a little on the frail side.
My Comment’s About Jack’s Reporting on Various Nutrients:
β-carotene / Vitamin A: This IS a nutrient of concern for some vegans but easy to get from diet. If you don’t eat your carrots, you may be deficient!
Zinc: Zinc intakes were lower in vegans in the studies from Switzerland and Germany. This is generally not a concern for most vegans (found in cashews, oats, and quinoa), but a nutrient to consider supplementing.
Iodine: Not a nutrient of concern for bone fractures, but IS a nutrient of concern for thyroid issues. Iodized salt, and sea vegetables are a good source.
Selenium: NOT a nutrient of concern for bone fractures though vegans in Germany were deficient, but MAY be a nutrient of concern for thyroid issues but is easily remedied by eating a small handful of Brazil nuts monthly.
Vitamin D: NOT a nutrient of concern for bone fractures, but IS a nutrient of concern for ALL people living above the 35th parallel. If you aren’t getting daily sunshine, you SHOULD be supplementing with 4,000 IU daily (see my article on Vitamin D status in elderly and dark skinned people, and COVID: https://www.arespectfullife.com/2020/07/03/why-vitamin-d3-is-important-for-seniors-and-dark-skinned-people-in-fighting-covid-19/ )
Calcium: NOT a nutrient of concern for bone fractures, and generally NOT a nutrient of concern for vegans, even though the dairy industry would have you believe otherwise. Most vegans eat enough beans, soy and leafy greens to ensure adequate calcium intake.
Protein: NOT a nutrient of concern for anyone eating enough calories. (See my article: ‘Where Do You Get Your Protein?’ https://www.arespectfullife.com/2019/03/31/but-where-do-you-get-your-protein/ .)
Vitamin B12: Does not appear to be a nutrient of concern for bone fractures, IS a nutrient that ALL vegans (and MOST other people) should be supplementing. (See my article: ‘Are You Getting Enough Vitamin B12’ https://www.arespectfullife.com/2017/05/22/getting-enough-b12/ )
Vitamin K2: NOT a nutrient of concern for bone fractures or vegans. K1 DOES convert to K2 and vegans get enough.
Iron: NOT a nutrient of concern for bone fractures. Generally not a nutrient of concern for vegans, but test instead of guessing. IF your blood work shows an iron deficiency or low red blood cell count (anemia), THEN you need to consider increasing your iron, and/or increasing your vitamin C intake because Vitamin C helps iron absorb.
Resistance Training: Likely a concern for bone fractures. Despite best efforts by the meat and dairy industry to overstate that vegans may be protein deficient and suffer from sarcopenia (muscle loss), there is no evidence of this in Western Societies unless you are not getting enough calories. You may have heard the term ‘MOVE IT OR LOSE IT’, and this is indeed true. If you want adequate muscle mass throughout your life, you need to develop healthy exercise habits, not increase your ‘protein’.
Given the observational nature of EPIC-Oxford, we should keep in mind that the higher bone fracture rate for vegans could be due to confounding factors. It’s also possible that a sub-optimal intake of multiple nutrients, especially in people with lower body mass index, could be responsible for the higher fracture rate and that’s why there’s no single, obvious culprit.
Inadequate intake can result from a lack of information about the importance of some nutrients or from a low caloric intake. The main nutrients of concern in the EPIC-Oxford cohort are vitamin A, zinc, and selenium, but vegans should pay attention to all nutrients on our Daily Needs page. Exercise involving weights and jumping is the most reliable way for otherwise healthy people to increase their bone mineral density; it also serves as a healthy way to increase body mass index and caloric intake.
Thank you Jack Norris for your exhaustive research on this topic! I hope I did a good job summarizing this information for my audience. Vegan Health UK is a fantastic and well researched source of information for vegans. I would encourage you to subscribe to their newsletter and check out their website for fantastic information concerning health topics for vegans at VeganHealth.org https://veganhealth.org/ .
As always, if you have any questions or comments about my content, please feel free to reach out to me directly: ctiexec @ gmail.