A Information to Vegan Bone Well being

Increase your vegan food regimen with bone well being nutritional vitamins and vitamins, together with calcium, vitamin D, and protein to guard your bones, in line with the most recent science. Study all about this vital challenge in A Information to Vegan Bone Well being. 

Right now, analysis reveals 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 kinds of most cancers. Nonetheless, a shadow has been forged over one potential well being concern: bone well being. Some research counsel that vegans could also be at greater danger for bone fracture, however the proof isn’t so clear-cut. Issue into the equation that confusion and myths abound over bone vitamin among the many vegan neighborhood, which can result in poorly deliberate diets. In the long run, it might be the kind of food regimen a vegan follows that issues greater than being vegan itself. So, the place does that depart you in relation to making essentially the most wise selections for bone well being vitamin? Most consultants agree that it’s finest to be cautious and keep on with the present suggestions for bone vitamins, like calcium, vitamin D, and protein. 

Elevating Vegan Bone Well being Considerations 

Osteoporosis is a critical public well being concern. This frequent power situation, marked by progressive lack of bone mineral density (BMD) and compromised bone energy, is related to rising danger of fracture over time. Over 200 million folks worldwide undergo from this illness, (1) and 30% of all postmenopausal ladies 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 complicated and is affected by many elements, together with vitamins, equivalent to calcium, nutritional vitamins D and B12, zinc, protein, and omega-3 fatty acids, in line with Katherine L Tucker, PhD, Professor of Dietary Epidemiology on the College of Massachusetts Lowell. Tucker, who’s a number one researcher on vitamin and bone well being, says that except one may be very cautious to make sure that all wanted vitamins are obtained, it’s straightforward for vegans to change into poor in these vital vitamins.

“An animal-free food regimen will be so wholesome and provide unbelievable advantages, however it’s laborious to disclaim that sure nutritional vitamins and minerals, equivalent to vitamin D and calcium, could have to be supplemented within the majority of vegans. Bone well being is a priority for all folks, however particularly these in sure classes that put them at greater danger. Any sort of food regimen must be deliberate to keep away from deficiencies in nutritional vitamins or minerals. Big research and meta-analyses have proven that vegans could also be at a barely greater danger for decreased bone density,” says Ginger Hultin, MS, RDN, CSO, previous chair of the Vegetarian Diet Dietetic Apply 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 examine, fracture charges within the U.Ok. have been in contrast in 4 food regimen teams: meat eaters, fish eaters, vegetarians, and vegans. Whereas the fish eaters and vegetarians had comparable charges of fractures because the meat eaters, the vegans had an incidence price ratio of 1.15. (4)

Nonetheless, not all analysis has discovered a better danger. One intriguing examine in contrast 105 Buddhist nuns, who have been lifelong vegans on account of spiritual rule, with 105 omnivorous ladies 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 kids and adolescents. “These are youth for bone improvement, and a poorly designed vegan food regimen throughout that point could also be a danger issue for bone well being, amongst many, many different danger elements that have to be considered,” says Hultin. “As much as 90 % of peak bone mass is acquired by age 18 in ladies. Girls who’ve a better bone mass are at decrease danger for osteoporosis later in life. Bone loss happens with growing old, however beginning with a better bone mass means much less danger of shedding a lot bone that osteoporosis develops,” says Reed Mangels, PhD, RD, LDN, Diet Adviser for The Vegetarian Useful resource Group.

In a examine 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 kids, although it’s vital to notice the small measurement of this examine. (6) In a bigger examine of fifty vegetarian and 50 omnivorous kids aged 2-10 years, markers of bone turnover have been discovered to be decrease in vegetarian kids in comparison with omnivorous kids. As well as, calcium and vitamin D consumption was two-fold decrease in vegetarian kids than omnivorous kids. (7)

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

That is vital as a result of it reveals that adults are liable for together with good sources of calcium in vegan kids’s diets. When no effort is made to incorporate good sources of calcium within the food regimen, it places kids in danger for fractures later in life. Good sources of calcium to incorporate in your youngster’s food regimen are mineral water, fortified plant-based milk, tofu, and inexperienced leafy veggies. The Academy of Diet and Dietetics’ present place helps vegan diets when appropriately deliberate to incorporate all important vitamins. The Academy addresses how vegan diets will be applicable at each life stage, together with childhood. (10) 

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

Moreover, a cross-sectional examine checked out a bunch 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 ends in bone loss at a quicker price) 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 have a look at the analysis it might be associated to poor nutrient consumption inside a vegan food regimen. Some research point out that vegans don’t have any better danger of osteoporosis, so long as their consumption of key bone vitamins, equivalent to calcium, vitamin D and protein, is sufficient.

The EPIC-Oxford examine discovered that amongst topics consuming at the very least 525 mg/day of calcium, the incidence price ratios of fractures have been 1.05 for fish eaters, 1.02 for vegetarians, and 1.00 for vegans. (4) Mangels explains, “This examine discovered that vegans had a better 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 by way of 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, nonetheless, there is no such thing as a proof that they’re at better danger for bone illness,” summarizes Virginia Messina, MPH, RD and creator of By no means Too Late to Go Vegan. Tucker agrees, however provides, “The truth is that many vegans wouldn’t have sufficient 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, usually related to bone well being. However incidence of hip fracture—essentially the most critical consequence of osteoporosis—has been highest in Sweden and North America worldwide, the place dairy consumption is distinguished. Hip fracture charges have been decrease in Asian and Latin American populations, the place dairy consumption is way decrease. (13) In line with a scientific evaluation, calcium consumption is way decrease in Asia and Africa, primarily because of the very low consumption of dairy merchandise, but the prevalence of osteoporosis is way decrease in these international locations 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 far more difficult than dairy merchandise and bone well being. Tucker explains that different diets from areas, equivalent to Asia, that don’t sometimes comprise calcium from dairy usually embrace small fish with bones and calcium-set tofu. “One could possibly get together with considerably much less calcium than at the moment really useful if different bone constructing vitamins are sufficient and in steadiness and within the surroundings 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 elements, for comparability, I don’t suppose they inform us an excessive amount of about food regimen and bone well being. Nevertheless it’s additionally clear that these populations have recognized different good methods to fulfill calcium wants. Asian populations, for instance, can get a lot of calcium from soyfoods and the cruciferous greens which might be frequent elements of their diets.”

Vegan Bone Myths 

Compounding the danger for bone well being points is a gradual supply of myths among the many vegan neighborhood. “Sadly, there continues to be plenty of outdated recommendation relating to food regimen 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 prompted calcium to be leached from bones. We all know now that protein is vital for robust bones and that vegans aren’t protected by the extra alkaline nature of their diets. However due to this misinformation, many vegans imagine that calcium isn’t vital and so they could not attempt to incorporate sufficient quantities of their food regimen. Some vegans may additionally imagine that they’re getting sufficient vitamin D from daylight, however it may be very tough to get sufficient in sure climates,” says Messina.

Matt Ruscigno, MPH, RD, a speaker and creator with a personal follow specializing in plant-based vitamin in Los Angeles, says, “There are robust emotions within the vegan neighborhood, with motive, about how the dairy business could affect calcium suggestions. Usually vegans suppose that they don’t want to fulfill calcium necessities as a result of they’re avoiding animal protein, as soon as thought to leach calcium from bones, however the analysis reveals they nonetheless do.”

Different issues 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’ll get every little thing they want from their food regimen,” which Mangels calls regarding. Selfmade and newly widespread manufacturers of plant milks could also be very low in protein, calcium and vitamin D, in comparison with fortified soymilks, which usually have very comparable 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 nicely established that calcium is vital for bone well being. The physique fastidiously regulates calcium ranges; if the focus within the blood, muscle groups or intercellular fluids is just too low, the physique takes calcium from the bones by resorption.

Latest analysis has created confusion over simply how a lot calcium is required, in addition to the influence of supplementation. The 2011 Dietary Reference Intakes really useful 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 suggestion just isn’t embraced around the globe. The U.Ok. suggests adults get 700 mg per day (16) and the World Well being Group as soon as really useful 400 – 500 mg of calcium for international locations with a excessive fracture incidence to forestall osteoporosis, however up to date their suggestion to 1000 mg for adults. (17) Throw into the combo 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 essential of the present suggestion 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 really want? Most of our consultants agree that it’s finest to be cautious and keep on with the present RDA. “Till we have now agency proof to counsel in any other case, I like to recommend that vegans meet the RDA for calcium,” says Messina. “It’s additionally vital to think about that analysis reveals 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 line with Messina. “Usually, vegans ought to focus on meals with excessive absorption as their essential sources of calcium. Bioavailability of calcium is superb from cruciferous greens like turnip greens, collards, mustard greens and kale. However it is rather poor from sure different greens, equivalent to 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 giant quantities of calcium-rich cruciferous greens they’ll in all probability get away with a bit of little bit of a decrease calcium consumption since bioavailability of calcium from these greens is so excessive,” says Messina. Mangels reviews that calcium from cruciferous, inexperienced greens is extra bioavailable than the calcium in cow’s milk.

The Greatest Bone Well being Dietary supplements for Vegans

And what about calcium dietary supplements? “Ideally, we must always get our calcium from meals. However for individuals who discover it tough to fulfill 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 aren’t ultimate, and {that a} heavy dose unexpectedly just isn’t integrated into our system. Nonetheless, calcium dietary supplements should be applicable for vegan purchasers.

Hultin notes that calcium was so “sizzling” 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 food regimen will be difficult, so the usage of some low dose supplementation and fortified meals will 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 every 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 examine discovered that vegans had the bottom intakes of vitamin D, in comparison with different food regimen patterns. (19) Because the main dietary sources of vitamin D is fortified dairy merchandise, fish and egg yolks, it is sensible that vegans’ consumption may be low. Vegan sources embrace fortified meals, equivalent to plant milks, orange juice, and cereals; mushrooms uncovered to mild, daylight publicity, and dietary supplements.

Many consultants suggest that vegans complement the food regimen with vitamin D. “Vitamin D is essential. There are few meals sources, and with out fish or milk, it is rather low in a vegan food regimen. 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 enough 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 principle 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 greater consumption of animal protein didn’t have an effect on the skeleton adversely. (19) In line with Tucker, who was a researcher on this examine, “The best protein intakes have been protecting. Over the long run, there seems to be elevated calcium absorption and elevated bone constructing with greater protein.”

Does it make a distinction what sort of protein vegans eat? Maybe not, in line with a 25-year examine of wrist fracture danger amongst ladies, which in contrast meat consumption and plant protein consumption. On this examine of practically 2,000 peri- and postmenopausal ladies, scientists discovered that vegetarians who consumed the least vegetable protein have been on the best 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 very best consumption reducing danger by 80%. The scientists concluded that greater consumption of meals wealthy in protein have been related to decreased wrist fracture, which helps the significance of sufficient protein for bone well being. But, the similarity in danger discount by vegetable protein meals in contrast with animal protein means that sufficient protein consumption is attainable in a vegetarian food regimen. (20)

Many vegans depend on fortified soymilk to interchange milk within the food regimen, thus offering wealthy sources of calcium, vitamin D, in addition to protein within the food regimen. In a 2014 article within the American Journal of Scientific Diet on bone vitamins for vegan diets, Mangels reported that bone well being is usually 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 ladies. 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 substitute, 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 Weight loss program Patterns and Bone Well being 

The potential bone influence of alkaline vs. acid diets has merited quite a lot of consideration in recent times. The idea is that some meals, specifically meats, dairy, eggs, grains, and processed meals, produce extra acid, whereas different meals, equivalent to fruits, greens, and legumes produce extra alkaline. However is there sufficient proof to counsel that this state of affairs gives vegans better bone safety?

Some analysis has advised that prime acid diets—typical within the Western food regimen—trigger calcium to be launched from the bones. Nonetheless, one latest examine discovered that prime acid diets with sufficient calcium consumption didn’t influence BMD. (23) One examine of German vegans discovered that food regimen didn’t have an effect on acid-base homeostasis. (24) A cross-sectional examine 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 aren’t detrimental to bone in younger adults, and that food regimen prescriptions for bone well being could range amongst food regimen 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 food regimen plan. (25)

Mangels says, “Whereas some analysis finds {that a} extra acid food regimen 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 food regimen just isn’t giant sufficient to result in elevated bone resorption. Moreover, a vegan food regimen does comprise meals that generate acid, equivalent to 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 better use of greens in a wholesome vegan food regimen will often assist the acid/base steadiness versus a typical Western food regimen and this does provide some benefit. Now we have discovered that fruit and vegetable consumption is protecting of bone mineral density,” says Tucker. Hultin’s viewpoint is that the acid/alkaline principle discredits different vital elements, together with adequacy of nutritional vitamins and minerals and applicable absorption. “Bone well being is multi-factorial and even when alkaline/acid diets play a task, there are different vital objects to think about. The acid or alkaline nature of a food regimen just isn’t sufficient to make sure bones will construct and preserve sufficient energy over time with out taking in sufficient 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 Ok, 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 essential for DNA methylation and rebuilding of bone, and inadequacy has been associated to fracture danger. “Vitamin B12 is just discovered to any extent in animal meals. This nutrient is essential for vegans and ought to be supplemented,” provides Tucker. In a examine of German vegetarians, vegans, and omnivores, researchers discovered that low vitamin B12 standing was associated to elevated bone turnover in vegetarian food regimen patterns, unbiased from vitamin D standing. (26)

Rising analysis reveals that omega-3 fatty acids have a task in bone metabolism, equivalent to on calcium steadiness and osteoblast exercise. (27) Consumption of omega-3 fatty acids is usually a drawback for vegans, in line 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 tough to get sufficient. There are new vegan dietary supplements of DHA accessible 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, equivalent to nutritional vitamins C and Ok, magnesium, potassium, and antioxidant compounds. Tucker says, “This does assist. Now we 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 food regimen gives phytonutrients that are anti-inflammatory and that is additionally useful to bone.”

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

Methods for Defending Bones

“I believe it’s best for vegans to fulfill with a dietitian to make sure that they’re taking in sufficient nutritional vitamins and minerals within the food regimen, assess danger elements on a private foundation, and focus on the appropriateness of supplementing. A dietitian can suggest any labs or assessments that have to be performed, equivalent to vitamin D blood labs or bone density scans, and focus on different danger elements equivalent to ethnicity, household historical past, physique weight, use of bone depleting drugs, or historical past of smoking or consuming problems. A dietitian can counsel food regimen and way of life elements 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 aren’t vegan, so it’s vital to establish ones which might be both vitamin D2 or the more durable to seek out vegan D3. Search for a food regimen wealthy in legumes, calcium-rich meals, and a every 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 understanding part of their well being plan.”

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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 ladies 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 examine 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 food regimen 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 kids. Adv Med Sci. 2007;52:279-82.
7. Koller A, Rohrmann S, Wakolbinger M, et al. Well being elements of vegan diets amongst kids and adolescents: a scientific evaluation 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. Progress, physique composition, and cardiovascular and dietary danger of 5- to 10-y-old kids 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 Diet and Dietetics: Vegetarian Diets. Journal of the Academy of Diet and Dietetics. 2016;116(12):1970-1980. doi:10.1016/j.jand.2016.09.025
10. Ambroszkiewicz J, Chełchowska M, Szamotulska Ok, et al. Bone standing and adipokine ranges in kids on vegetarian and omnivorous diets. Scientific Diet. 2019;38(2):730-737. doi:10.1016/j.clnu.2018.03.010
11. Menzel J, Abraham Ok, Stangl GI, Ueland PM, Obeid R, Schulze MB, Herter-Aeberli I, Schwerdtle T, Weikert C. Vegan food regimen and bone well being—Outcomes from the cross-sectional RBVD examine. 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 international locations. 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 Medication. Dietary Reference Intakes for Calcium and Vitamin D. 2011. Washington, DC: The Nationwide Academies Press.
16. Michaelsson Ok. Calcium dietary supplements don’t stop fractures. British Medical Journal. 2015;351:h4825.
17. World Well being Group. Joint WHO/FAO Professional Session on Weight loss program, Diet and the Prevention of Persistent Ailments: Suggestions for stopping osteoporosis. WHO Technical Report Collection, 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 examine. 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 Girls: 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 food regimen on danger of wrist fracture over 25 years in a cohort of peri- and postmenopausal ladies. 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 evaluation of preliminary revealed 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. Weight loss program-dependent web 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 position 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.

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