A Information to Vegan Bone Well being

Enhance your vegan weight loss plan with bone well being nutritional vitamins and vitamins, together with calcium, vitamin D, and protein to guard your bones, in keeping with the newest science. Study all about this vital challenge in A Information to Vegan Bone Well being. 

As we speak, analysis exhibits us that well-planned vegan diets, that are void of all animal merchandise, together with meat, fish, poultry, dairy, and eggs, could also be linked with quite a few well being advantages, together with decrease dangers of coronary heart illness, sort 2 diabetes, weight problems, and sure sorts of most cancers. Nonetheless, a shadow has been solid over one potential well being concern: bone well being. Some research recommend that vegans could also be at increased danger for bone fracture, however the proof isn’t so clear-cut. Issue into the equation that confusion and myths abound over bone diet among the many vegan neighborhood, which can result in poorly deliberate diets. Ultimately, it might be the kind of weight loss plan a vegan follows that issues greater than being vegan itself. So, the place does that go away you in the case of making essentially the most wise selections for bone well being diet? Most consultants agree that it’s finest to be cautious and stick to the present suggestions for bone vitamins, like calcium, vitamin D, and protein. 

Elevating Vegan Bone Well being Issues 

Osteoporosis is a severe public well being concern. This widespread power situation, marked by progressive lack of bone mineral density (BMD) and compromised bone power, is related to rising danger of fracture over time. Over 200 million individuals worldwide undergo from this illness, (1) and 30% of all postmenopausal girls within the US and Europe have osteoporosis. (2)

The method of bone mineralization (the laying down of minerals on the bone matrix) and resorption (when osteoclasts break down bone and launch calcium into the blood) is advanced and is affected by many components, together with vitamins, resembling calcium, nutritional vitamins D and B12, zinc, protein, and omega-3 fatty acids, in keeping with Katherine L Tucker, PhD, Professor of Dietary Epidemiology on the College of Massachusetts Lowell. Tucker, who’s a number one researcher on diet and bone well being, says that except one could be very cautious to make sure that all wanted vitamins are obtained, it’s simple for vegans to turn into poor in these vital vitamins.

“An animal-free weight loss plan could be so wholesome and provide unbelievable advantages, however it’s arduous to disclaim that sure nutritional vitamins and minerals, resembling vitamin D and calcium, might have to be supplemented within the majority of vegans. Bone well being is a priority for all individuals, however particularly these in sure classes that put them at increased danger. Any sort of weight loss plan must be deliberate to keep away from deficiencies in nutritional vitamins or minerals. Large research and meta-analyses have proven that vegans could also be at a barely increased danger for decreased bone density,” says Ginger Hultin, MS, RDN, CSO, previous chair of the Vegetarian Vitamin Dietetic Follow Group. 

In a 2009 meta-analysis of research trying on the results of vegetarian diets on BMD, scientists discovered that, in contrast with omnivores, vegans had decrease lumbar backbone BMD, though the findings weren’t clinically vital. (3) And within the EPIC-Oxford research, fracture charges within the U.Okay. have been in contrast in 4 weight loss plan teams: meat eaters, fish eaters, vegetarians, and vegans. Whereas the fish eaters and vegetarians had related charges of fractures because the meat eaters, the vegans had an incidence fee ratio of 1.15. (4)

Nonetheless, not all analysis has discovered a higher danger. One intriguing research in contrast 105 Buddhist nuns, who have been lifelong vegans attributable to non secular rule, with 105 omnivorous girls from monasteries in Ho Chi Minh Metropolis. They discovered that the median consumption of calcium amongst vegans was decrease, but it was not correlated with BMD. (5)

One other concern is the influence of veganism on bone well being amongst youngsters and adolescents. “These are youth for bone improvement, and a poorly designed vegan weight loss plan throughout that point could also be a danger issue for bone well being, amongst many, many different danger components that have to be considered,” says Hultin. “As much as 90 % of peak bone mass is acquired by age 18 in women. Ladies who’ve the next bone mass are at decrease danger for osteoporosis later in life. Bone loss happens with getting old, however beginning with the next bone mass means much less danger of shedding a lot bone that osteoporosis develops,” says Reed Mangels, PhD, RD, LDN, Vitamin Adviser for The Vegetarian Useful resource Group.

In a research of 1 vegan household, scientists discovered low dietary consumption of calcium and vitamin D was linked to decrease BMD, which was much more pronounced within the youngsters, although it’s vital to notice the small measurement of this research. (6) In a bigger research of fifty vegetarian and 50 omnivorous youngsters aged 2-10 years, markers of bone turnover have been discovered to be decrease in vegetarian youngsters in comparison with omnivorous youngsters. As well as, calcium and vitamin D consumption was two-fold decrease in vegetarian youngsters than omnivorous youngsters. (7)

A latest meta-analysis “confirmed a 40% (confidence interval from -64% to 0%) decrease calcium consumption amongst vegan youngsters however no distinction in vitamin D consumption (8).” Moreover, a single research included within the evaluation “in contrast bone mineral content material (BMC) of the lumbar backbone and complete physique between vegan and omnivorous youngsters” and located that “each have been decrease within the vegan group (9).“ 

That is vital as a result of it exhibits that adults are chargeable for together with good sources of calcium in vegan youngsters’s diets. When no effort is made to incorporate good sources of calcium within the weight loss plan, it places youngsters in danger for fractures later in life. Good sources of calcium to incorporate in your little one’s weight loss plan are mineral water, fortified plant-based milk, tofu, and inexperienced leafy veggies. The Academy of Vitamin and Dietetics’ present place helps vegan diets when appropriately deliberate to incorporate all important vitamins. The Academy addresses how vegan diets could be acceptable at each life stage, together with childhood. (10) 

A separate research discovered that complete lumbar backbone bone mineral density scores in vegetarian youngsters have been decrease, whereas absolute values of bone mineral densities didn’t differ from omnivorous youngsters. Vegetarian youngsters had decrease leptin ranges and fewer complete physique fats (11). 

Moreover, a cross-sectional research checked out a gaggle of 36 vegans and 36 omnivores. It discovered that vegans had statistically vital decrease concentrations of urinary calcium and better ranges of PTH (parathyroid hormone). Parathyroid hormone causes an total lack of bone mass because it stimulates the resorption of bone whereas rising osteoblast (bone-building) exercise. The degrees of the B12, B6, and thyroid-stimulating hormone (low TSH leads to bone loss at a quicker fee) weren’t statistically vital between the 2 teams (12). 

Bone Well being is About Vitamins, not Veganism

Whereas it might seem that vegans are in danger for decrease BMD, when taking a better take a look at the analysis it might be associated to poor nutrient consumption inside a vegan weight loss plan. Some research point out that vegans don’t have any higher danger of osteoporosis, so long as their consumption of key bone vitamins, resembling calcium, vitamin D and protein, is satisfactory.

The EPIC-Oxford research discovered that amongst topics consuming at the very least 525 mg/day of calcium, the incidence fee ratios of fractures have been 1.05 for fish eaters, 1.02 for vegetarians, and 1.00 for vegans. (4) Mangels explains, “This research discovered that vegans had the next danger of fractures than did different vegetarians or nonvegetarians. When solely vegans with calcium intakes above the UK Estimated Common Requirement for calcium have been included within the evaluation, there was no distinction between any of the teams when it comes to fracture incidence.”

“Bone well being is a priority for vegans who’ve low intakes of calcium, protein and vitamin D. So long as vegans are consuming a nutritious diet, nevertheless, there isn’t any proof that they’re at higher danger for bone illness,” summarizes Virginia Messina, MPH, RD and writer of By no means Too Late to Go Vegan. Tucker agrees, however provides, “The fact is that many vegans should not have satisfactory intakes of those vitamins.”

Classes about Vegan Bone Well being from Across the World 

Some consultants level to the truth that vegans’ bone danger could also be associated to avoiding dairy merchandise, typically related to bone well being. However incidence of hip fracture—essentially the most severe consequence of osteoporosis—has been highest in Sweden and North America worldwide, the place dairy consumption is outstanding. Hip fracture charges have been decrease in Asian and Latin American populations, the place dairy consumption is far decrease. (13) Based on a scientific overview, calcium consumption is far decrease in Asia and Africa, primarily because of the very low consumption of dairy merchandise, but the prevalence of osteoporosis is far decrease in these nations than within the U.S. and Europe. (14) About 75 % of the world’s inhabitants loses their lactose enzymes after weaning, which raises the query about whether or not dairy merchandise are important to bone well being. 

Nonetheless, the dialogue is rather more difficult than dairy merchandise and bone well being. Tucker explains that different diets from areas, resembling Asia, that don’t sometimes comprise calcium from dairy typically embrace small fish with bones and calcium-set tofu. “One could possibly get together with considerably much less calcium than at present beneficial if different bone constructing vitamins are satisfactory and in steadiness and within the atmosphere of constant weight bearing train,” provides Tucker.

Messina says, “Since these are ecological comparisons and infrequently use hip fracture charges, that are affected by many components, for comparability, I don’t suppose they inform us an excessive amount of about weight loss plan and bone well being. However it’s additionally clear that these populations have recognized different good methods to satisfy calcium wants. Asian populations, for instance, can get plenty of calcium from soyfoods and the cruciferous greens which can be widespread elements of their diets.”

Vegan Bone Myths 

Compounding the danger for bone well being points is a gentle supply of myths among the many vegan neighborhood. “Sadly, there continues to be quite a lot of outdated recommendation concerning weight loss plan and bone well being. Many vegans suppose that their decrease protein consumption protects bone well being as a result of older pondering was that protein brought on calcium to be leached from bones. We all know now that protein is vital for sturdy bones and that vegans usually are not protected by the extra alkaline nature of their diets. However due to this misinformation, many vegans consider that calcium isn’t vital they usually might not try to incorporate satisfactory quantities of their weight loss plan. Some vegans may consider that they’re getting sufficient vitamin D from daylight, however it may be very troublesome to get sufficient in sure climates,” says Messina.

Matt Ruscigno, MPH, RD, a speaker and writer with a personal observe specializing in plant-based diet in Los Angeles, says, “There are sturdy emotions within the vegan neighborhood, with purpose, about how the dairy trade might affect calcium suggestions. Typically vegans suppose that they don’t want to satisfy calcium necessities as a result of they’re avoiding animal protein, as soon as thought to leach calcium from bones, however the analysis exhibits they nonetheless do.”

Different considerations contain a homespun development that finds vegans making their very own (unfortified) plant milks and avoiding fortified meals or dietary supplements with the sensation “they will get every thing they want from their weight loss plan,” which Mangels calls regarding. Home made and newly widespread manufacturers of plant milks could also be very low in protein, calcium and vitamin D, in comparison with fortified soymilks, which generally have very related protein, calcium and vitamin D ranges as dairy milk.

Calcium for Bone Well being 

Of specific concern amongst vegans is calcium consumption and its relationship to bone well being, particularly contemplating the shortage of dairy merchandise of their diets. It’s been properly established that calcium is vital for bone well being. The physique rigorously regulates calcium ranges; if the focus within the blood, muscle groups or intercellular fluids is simply too low, the physique takes calcium from the bones by way of resorption.

Current analysis has created confusion over simply how a lot calcium is required, in addition to the influence of supplementation. The 2011 Dietary Reference Intakes beneficial an RDA of 1,000 mg for many adults 19 – 70 years of age, and 1,200 mg for ladies over 50 and males over 70. (15) Nonetheless, this advice just isn’t embraced world wide. The U.Okay. suggests adults get 700 mg per day (16) and the World Well being Group as soon as beneficial 400 – 500 mg of calcium for nations with a excessive fracture incidence to stop osteoporosis, however up to date their advice to 1000 mg for adults. (17) Throw into the combination that some (however not all) research have linked calcium dietary supplements with an elevated danger for heart problems in aged adults. Some well being organizations are crucial of the present advice for calcium, in addition to the variety of servings of dairy merchandise within the USDA MyPlate. For instance, the Harvard T. H. Chan College of Public Well being’s Wholesome Consuming Plate doesn’t embrace dairy merchandise as an integral part of a nutritious diet. (18)

So, how a lot calcium do you actually need? Most of our consultants agree that it’s finest to be cautious and stick to the present RDA. “Till we’ve agency proof to recommend in any other case, I like to recommend that vegans meet the RDA for calcium,” says Messina. “It’s additionally vital to contemplate that analysis exhibits vegans might not be assembly their calcium wants,” provides Mangels.

The place ought to the calcium come from? That is one other misunderstood space, in keeping with Messina. “Usually, vegans ought to focus on meals with excessive absorption as their major sources of calcium. Bioavailability of calcium is great from cruciferous greens like turnip greens, collards, mustard greens and kale. However it is vitally poor from sure different greens, resembling spinach, Swiss chard, and beet greens. It’s additionally good from soyfoods and fortified plant milks, however calcium is absorbed at a lot decrease charges from different legumes and from nuts and seeds. If vegans are consuming massive quantities of calcium-rich cruciferous greens they will in all probability get away with a little bit little bit of a decrease calcium consumption since bioavailability of calcium from these greens is so excessive,” says Messina. Mangels stories that calcium from cruciferous, inexperienced greens is extra bioavailable than the calcium in cow’s milk.

The Finest Bone Well being Dietary supplements for Vegans

And what about calcium dietary supplements? “Ideally, we must always get our calcium from meals. However for many who discover it troublesome to satisfy wants it’s okay to make up the distinction with a low-dose complement—about 300 mg per day,” says Messina. Tucker provides that dietary supplements usually are not superb, and {that a} heavy dose suddenly just isn’t integrated into our system. Nonetheless, calcium dietary supplements should still be acceptable for vegan purchasers.

Hultin notes that calcium was so “scorching” and given routinely to most individuals not so way back. She believes that fears over cardiovascular dangers have modified all that, however that analysis on this space wants additional exploration. She says, “Getting a full 1,000 mg within the weight loss plan could be difficult, so using some low dose supplementation and fortified meals could be very useful in assembly the suggestions.”

Vitamin D for Bone Well being

Vitamin D is vital for bone well being, too; it’s required for absorption of calcium. The Dietary Reference Intakes report recommends 600 IUs of vitamin D each day for adults 19 – 70 years of age. (15) Whereas vitamin D is a shortfall nutrient for all Individuals, it’s much more of a priority for vegans. The EPIC-Oxford research discovered that vegans had the bottom intakes of vitamin D, in comparison with different weight loss plan patterns. (19) For the reason that main dietary sources of vitamin D is fortified dairy merchandise, fish and egg yolks, it is smart that vegans’ consumption may be low. Vegan sources embrace fortified meals, resembling plant milks, orange juice, and cereals; mushrooms uncovered to mild, daylight publicity, and dietary supplements.

Many consultants advocate that vegans complement the weight loss plan with vitamin D. “Vitamin D is crucial. There are few meals sources, and with out fish or milk, it is vitally low in a vegan weight loss plan. Whereas 10 minutes/day with uncovered pores and skin in good daylight is okay in the summertime, throughout winter months dietary supplements could also be wanted to acquire ample vitamin D,” says Tucker. 

Protein for Bone Well being 

A rising physique of analysis factors to the significance of protein in bone well being, regardless of an older concept that decrease protein consumption protected calcium in bones. Extra protein could also be related to adverse calcium steadiness, however low protein take has been related to fracture. Within the Framingham Osteoporosis Examine, aged women and men with decrease protein consumption had elevated bone loss. Additionally they discovered that increased consumption of animal protein didn’t have an effect on the skeleton adversely. (19) Based on Tucker, who was a researcher on this research, “The very best protein intakes have been protecting. Over the long run, there seems to be elevated calcium absorption and elevated bone constructing with increased protein.”

Does it make a distinction what sort of protein vegans devour? Maybe not, in keeping with a 25-year research of wrist fracture danger amongst girls, which in contrast meat consumption and plant protein consumption. On this research of almost 2,000 peri- and postmenopausal girls, scientists discovered that vegetarians who consumed the least vegetable protein have been on the biggest danger for wrist fracture. Nonetheless, rising ranges of plant proteins decreased wrist fracture danger, with a 68% discount in danger within the highest consumption group. Amongst these with the bottom vegetable protein consumption, rising meat consumption decreased the danger of wrist fracture, with the best consumption reducing danger by 80%. The scientists concluded that increased consumption of meals wealthy in protein have been related to decreased wrist fracture, which helps the significance of satisfactory protein for bone well being. But, the similarity in danger discount by vegetable protein meals in contrast with animal protein means that satisfactory protein consumption is attainable in a vegetarian weight loss plan. (20)

Many vegans depend on fortified soymilk to interchange milk within the weight loss plan, thus offering wealthy sources of calcium, vitamin D, in addition to protein within the weight loss plan. In a 2014 article within the American Journal of Scientific Vitamin on bone vitamins for vegan diets, Mangels reported that bone well being is commonly related to the consumption of dairy merchandise to offer bone well being vitamins, but plant-based sources additionally provide these bone-loving vitamins. (21) Within the Adventist Well being Examine 2, scientists in contrast the bone results of soymilk consumption and dairy consumption amongst 337 postmenopausal white girls. Consuming at the very least 1 serving of soymilk per day was related to improved bone well being to an analogous diploma as dairy in vegetarian diets, main the researchers to conclude that it might be a helpful alternative, presumably associated to its protein and calcium content material. The protein content material of unfortified soy milk is 3.27 g/100 g, in contrast with 3.15 g/100 g for complete milk; the calcium contents of unfortified and fortified soy milks are 25 mg/100 g and 123 mg/100 g, respectively, in contrast with a calcium content material of 113 mg/100 g for complete milk. (22)

Alkaline Food regimen Patterns and Bone Well being 

The potential bone influence of alkaline vs. acid diets has merited an excessive amount of consideration lately. The idea is that some meals, particularly meats, dairy, eggs, grains, and processed meals, produce extra acid, whereas different meals, resembling fruits, greens, and legumes produce extra alkaline. However is there sufficient proof to recommend that this situation gives vegans higher bone safety?

Some analysis has advised that top acid diets—typical within the Western weight loss plan—trigger calcium to be launched from the bones. Nonetheless, one latest research discovered that top acid diets with satisfactory calcium consumption didn’t influence BMD. (23) One research of German vegans discovered that weight loss plan didn’t have an effect on acid-base homeostasis. (24) A cross-sectional research of younger grownup vegetarians, vegans and omnivores discovered that urinary pH was extra alkaline amongst vegetarians and vegans, but it was related to BMD in omnivores solely, and protein consumption was related to BMD solely amongst vegan diets. The scientists concluded that plant-based diets usually are not detrimental to bone in younger adults, and that weight loss plan prescriptions for bone well being might differ amongst weight loss plan teams, together with suggestions for elevated fruit and vegetable consumption for people with excessive meat intakes and elevated plant protein consumption for people who comply with a vegetarian weight loss plan plan. (25)

Mangels says, “Whereas some analysis finds {that a} extra acid weight loss plan may result in elevated osteoclatic exercise and elevated bone resorption, newer analysis means that the serum pH change that happens in response to an acid-generating weight loss plan just isn’t massive sufficient to result in elevated bone resorption. Moreover, a vegan weight loss plan does comprise meals that generate acid, resembling soy merchandise, corn, wheat and rice. The potential acid-producing impact of those meals could also be offset by a excessive fruit and vegetable consumption, since vegetables and fruit have an alkalizing impact. So, it appears to me that what’s vital is to eat loads of vegetables and fruit.”

“The higher use of greens in a wholesome vegan weight loss plan will often assist the acid/base steadiness versus a typical Western weight loss plan and this does provide some benefit. We now have discovered that fruit and vegetable consumption is protecting of bone mineral density,” says Tucker. Hultin’s viewpoint is that the acid/alkaline concept discredits different vital components, together with adequacy of nutritional vitamins and minerals and acceptable absorption. “Bone well being is multi-factorial and even when alkaline/acid diets play a task, there are different vital objects to contemplate. The acid or alkaline nature of a weight loss plan just isn’t sufficient to make sure bones will construct and preserve satisfactory power over time with out taking in satisfactory bone constructing minerals,” provides Hultin.

Different Bone Vitamins 

Analysis is shining the sunshine on different bone-protective vitamins past calcium, vitamin D and protein. “Vitamins, along with calcium, vitamin D, and protein, embrace phosphorus, magnesium, zinc, copper, manganese, vitamin C, vitamin B12, vitamin Okay, and potassium,” says Mangels.

Of specific curiosity is the influence of vitamin B12, which is low in vegan diets except it’s supplemented. Tucker explains that vitamin B12 is crucial for DNA methylation and rebuilding of bone, and inadequacy has been associated to fracture danger. “Vitamin B12 is simply discovered to any extent in animal meals. This nutrient is essential for vegans and ought to be supplemented,” provides Tucker. In a research of German vegetarians, vegans, and omnivores, researchers discovered that low vitamin B12 standing was associated to elevated bone turnover in vegetarian weight loss plan patterns, unbiased from vitamin D standing. (26)

Rising analysis exhibits that omega-3 fatty acids have a task in bone metabolism, resembling on calcium steadiness and osteoblast exercise. (27) Consumption of omega-3 fatty acids could be a drawback for vegans, in keeping with Tucker, since consumption comes primarily from fish. “Plant sources are restricted, however embrace walnuts and flax seeds, however the alpha-linolenic from these sources just isn’t as environment friendly because the DHA/EPA from fish, so it’s troublesome to get sufficient. There are new vegan dietary supplements of DHA out there from algae, however few research have evaluated them,” provides Tucker.

On the intense aspect, vegan diets are very excessive in complete grains, nuts, seeds, fruits, greens, and legumes, thus they’re wealthy in lots of bone protecting vitamins, resembling nutritional vitamins C and Okay, magnesium, potassium, and antioxidant compounds. Tucker says, “This does assist. We now have seen protecting results of vitamin C and beta-carotene from fruit and greens. The magnesium and potassium from these, in addition to complete grains and nuts are additionally protecting. Along with nutritional vitamins and minerals, a plant-based weight loss plan gives phytonutrients that are anti-inflammatory and that is additionally useful to bone.”

And, it’s vital to contemplate way of life components that may influence bone well being, resembling train and a wholesome weight. “Vegans—and all individuals—ought to be paying shut consideration to different protecting way of life components, resembling weight bearing bodily exercise and sustaining an acceptable physique weight. Research have proven that vegans typically preserve a decrease physique weight than omnivores or vegetarians. Physique stature and body measurement can have an effect on bone well being with slighter of us, particularly those that are underweight, being at higher danger for osteoporosis,” says Hultin.

Methods for Defending Bones

“I feel it’s best for vegans to satisfy with a dietitian to make sure that they’re taking in satisfactory nutritional vitamins and minerals within the weight loss plan, assess danger components on a private foundation, and focus on the appropriateness of supplementing. A dietitian can advocate any labs or assessments that have to be finished, resembling vitamin D blood labs or bone density scans, and focus on different danger components resembling ethnicity, household historical past, physique weight, use of bone depleting medicines, or historical past of smoking or consuming problems. A dietitian can recommend weight loss plan and way of life components to help bone well being in vegans,” says Hultin.

Messina suggests, “Be educated about vegan sources of well-absorbed calcium and vitamin D. Most dietary supplements usually are not vegan, so it’s vital to determine ones which can be both vitamin D2 or the tougher to seek out vegan D3. Search for a weight loss plan wealthy in legumes, calcium-rich meals, and a each day supply of vitamin D.”

Ruscigno says, “Weight bearing train is a really essential a part of bone well being and I like to recommend all of my purchasers make figuring out part of their well being plan.”

Study extra about bone well being in these blogs:

References: 

1. Cooper C, Campion G, Melton LJ third. Hip fractures within the aged: a world-wide projection. Osteoporos Int. 1992 Nov;2(6):285-9.
2. Melton III LJ, Chrischilles EA, Cooper C, Lane AW, Riggs BL: Perspective: What number of girls have osteoporosis? J Bone Miner Res 1992;7:1005-10.
3. Ho-Pham LT, Nguyen ND, Nguyen TV. Impact of vegetarian diets on bone mineral density: a Bayesian meta-analysis. Am J Clin Nutr. 2009 Oct;90(4):943-50.
4. Appleby P1, Roddam A, Allen N, Key T. Comparative fracture danger in vegetarians and nonvegetarians in EPIC-Oxford. Eur J Clin Nutr. 2007 Dec;61(12):1400-6.
5. Ho-Pham LT1, Nguyen PL, Le TT, Doan TA, Tran NT, Le TA, Nguyen TV. Veganism, bone mineral density, and physique composition: a research in Buddhist nuns. Osteoporos Int. 2009 Dec;20(12):2087-93.
6. Ambroszkiewicz J, Klemarczyk W, Gajewska J, Chełchowska M, Franek E, Laskowska-Klita T. The affect of vegan weight loss plan on bone mineral density and biochemical bone turnover markers. Pediatr Endocrinol Diabetes Metab. 2010;16(3):201-4.
   7. Ambroszkiewicz J1, Klemarczyk W, Gajewska J, Chełchowska M, Laskowska-Klita T. Serum focus of biochemical bone turnover markers in vegetarian youngsters. Adv Med Sci. 2007;52:279-82.
7. Koller A, Rohrmann S, Wakolbinger M, et al. Well being points of vegan diets amongst youngsters and adolescents: a scientific overview and meta-analyses. Crit Rev Meals Sci Nutr. :1-12. doi:10.1080/10408398.2023.2263574
8. Desmond MA, Sobiecki JG, Jaworski M, et al. Development, physique composition, and cardiovascular and dietary danger of 5- to 10-y-old youngsters consuming vegetarian, vegan, or omnivore diets. Am J Clin Nutr. 2021;113(6):1565-1577. doi:10.1093/ajcn/nqaa445
9. Melina V, Craig W, Levin S. Place of the Academy of Vitamin and Dietetics: Vegetarian Diets. Journal of the Academy of Vitamin and Dietetics. 2016;116(12):1970-1980. doi:10.1016/j.jand.2016.09.025
10. Ambroszkiewicz J, Chełchowska M, Szamotulska Okay, et al. Bone standing and adipokine ranges in youngsters on vegetarian and omnivorous diets. Scientific Vitamin. 2019;38(2):730-737. doi:10.1016/j.clnu.2018.03.010
11. Menzel J, Abraham Okay, Stangl GI, Ueland PM, Obeid R, Schulze MB, Herter-Aeberli I, Schwerdtle T, Weikert C. Vegan weight loss plan and bone well being—Outcomes from the cross-sectional RBVD research. Vitamins. 2021; 13(2):685. https://doi.org/10.3390/nu13020685
12. Dhanwal DK, Dennison EM, Harvey NC, Cooper C. Epidemiology of hip fracture: Worldwide geographic variation. Indian J Orthop. 2011 Jan-Mar; 45(1):15–22.
13. Tsukahara N1, Ezawa I. Calcium consumption and osteoporosis in lots of nations. Clin Calcium. 2001 Feb;11(2):173-7.
    
14. Hertzler SR, Huynh BCL, Savaiano DA. How a lot lactose is low lactose? J Am Dietetic Assoc. 1996;96:243-246.
15. Institute of Drugs. Dietary Reference Intakes for Calcium and Vitamin D. 2011. Washington, DC: The Nationwide Academies Press.
16. Michaelsson Okay. Calcium dietary supplements don’t forestall fractures. British Medical Journal. 2015;351:h4825.
17. World Well being Group. Joint WHO/FAO Skilled Session on Food regimen, Vitamin and the Prevention of Continual Illnesses: Suggestions for stopping osteoporosis. WHO Technical Report Sequence, No. 916 (TRS 916). 2003.
18. Crowe FL, Steur M, Allen NE, Appleby PN, Travis RC, Key TJ. Plasma concentrations of 25-hydroxyvitamin D in meat eaters, fish eaters, vegetarians and vegans: outcomes from the EPIC-Oxford research. Public Well being Nutr. 2011;14(2):340-346.
19. Hannan MT, Tucker, KL, Dawson-Hughes B, Cupples LA, Felson DT, Kiel DP. Impact of Dietary Protein on Bone Loss in Aged Males and Ladies: The Framingham Osteoporosis Examine. Journal of Bone and Mineral Analysis. 2000; (15)12:2504-2512.
20. Thorpe DL1, Knutsen SF, Beeson WL, Rajaram S, Fraser GE. Results of meat consumption and vegetarian weight loss plan on danger of wrist fracture over 25 years in a cohort of peri- and postmenopausal girls. Public Well being Nutr. 2008 Jun;11(6):564-72.
21. Mangels AR. Bone vitamins for vegetarians. Am J Clin Nutr. 2014 Jul;100 Suppl 1:469S-75S.
22. Orlich MJ, Fraser GE. Vegetarian diets within the Adventist Well being Examine 2: a overview of preliminary printed findings. Am J Clin Nutr. 2014 Jul; 100(1):353S–358S.
23. Mangano KM, Walsh SJ, Kenny AM, Insogna KL, Kerstetter JE. Dietary acid load is related to decrease bone mineral density in males with low consumption of dietary calcium. J Bone Miner Res. 2014 Feb;29(2):500-6.
24. Ströhle A, Waldmann A, Koschizke J, Leitzmann C, Hahn A. Food regimen-dependent internet endogenous acid load of vegan diets in relation to meals teams and bone health-related vitamins: outcomes from the German Vegan Examine. Ann Nutr Metab. 2011;59(2-4):117-26.
25. Knurick JR, Johnston CS, Wherry SJ, Aguayo I. Comparability of correlates of bone mineral density in people adhering to lacto-ovo, vegan, or omnivore diets: a cross-sectional investigation. Vitamins. 2015 Might 11;7(5):3416-26.
26. Herrmann W, Obeid R, Schorr H, Hübner U, Geisel J, Sand-Hill M, Ali N, Herrmann M. Enhanced bone metabolism in vegetarians—the function of vitamin B12 deficiency. Clin Chem Lab Med. 2009;47(11):1381-7
27. Maggio M1, Artoni A, Lauretani F, Borghi L, Nouvenne A, Valenti G, Ceda GP. The influence of omega-3 fatty acids on osteoporosis. Curr Pharm Des. 2009;15(36):4157-64.

Extra Instruments for Consuming and Residing the Goodness