This looks like good news for just about anyone whose meat consumption is minimal or zero. It appears all you have to do is make sure you get enough Calcium. Did people already know this before Feb 23rd or is this truly the groundbreaking research that they claim it is? I assume Vitamin D and phosphorus would also be a bit important but this study exposes the root cause of all the disturbing date from past studies into bone and mineral health of vegetarians:

(The tables did not paste correctly and look much better at the link)

http://www.veganhealth.org/articles/bones

New Study Answers Questions about the Vegan Diet, Calcium, and Bone Health

February 23, 2007 - by Jack Norris, RD

If you've been a vegan for long, you've probably heard that:

* Too much protein, especially animal protein, is the major cause of osteoporosis.
* Not only does dairy not protect against osteoporosis, it actually contributes to it.
* Calcium intake isn't very important for protecting against osteoporosis.

Finally, you might have come to the conclusion that the lower levels of protein in a vegan diet protect against osteoporosis.

For almost ten years now, Vegan Outreach has cautioned vegans that the jury was still out on these issues and that vegans should try to meet the U.S. recommended intakes for calcium. In recent years, the evidence has been mounting against the above statements. In February of 2007, a study was released,14 the first study of its kind, that gives us pretty good answers to these questions.

The EPIC-Oxford study recruited 57,000 participants, including over 1,000 vegans and almost 10,000 lacto-ovo vegetarians (LOV), 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.

That's not good news; in fact, it's something I've feared for some time now given the vegan propaganda about animal protein, calcium, and bones which has fostered complacency among vegans about calcium and vitamin D.

Yet, there is some good news in this study. When calcium intake was adjusted for, the vegans no longer had a higher rate of fractures. And among the 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. (And if you're wondering about how the other diet groups (meat-eaters, fish-eaters, and LOV) fared over all, none of them differed from each other in any of the analyses performed.)

Does this mean lower calcium intakes are the cause of the fractures? It could be that people who eat more calcium also eat more or less protein or get more vitamin D. The authors noted that fracture rates did not correlate with protein or vitamin D intake among the people in this study. For now, we should assume that calcium is what the vegans with higher fracture rates were lacking.

The study did not measure calcium intake from supplements. I'm not sure if this affected the results, but for now I would assume it did not.

The US recommended intake for calcium is 1,000 mg for most adults. The UK's recommended intake is 700 mg. You can get this much calcium by having 3 servings of high calcium foods (fortified drinks, large portion of high calcium greens, and calcium tablets) each day. I drink soymilk fortified with calcium on most days and take a 500 mg calcium pill each night before bed.

More information on calcium, vitamin D, and bones can be found below.

Bone Health

Not a whole lot is known about the bone status of vegans. Some small studies have shown vegans to have the same or slightly worse bone mineral density as non-vegans.9, 10, 11, 12, 13 These studies were among vegans who possibly did not get much vitamin D or make an effort to get the recommended amount of calcium in their diet. There is no reason why a vegan cannot get every bit as much calcium in their diet as the typical meat or dairy eater. See below under Calcium as to how.

Unfortunately, many vegan advocates continue to use outdated theories to promote the idea that animal protein is the cause of osteoporosis. To be sure, the question of what causes osteoporosis is complicated (with many factors listed directly below). It is this author's opinion that eating too much animal protein is not a significant cause of osteoporosis for Americans, nor does removing animal protein from the diet in itself significantly lower one's needs for calcium. An interesting, though by no means exhaustive, article on the subject is Dietary Protein and Calcium: Are They Friends or Foes? which starts on p. 4 of the Summer 2004 issue (PDF) of The Soy Connection. The article concludes:

Recent evidence has demonstrated that increased intake of common proteins does not necessarily affect bone health adversely. The composition of the protein source as well as co-existing factors in the total diet determines the renal acid load. In healthy individuals consuming high protein foods, in the context of typical mixed diets, the renal acid load does not seem to reach a "threshold" that affects calcium homeostasis.

Factors that can prevent osteoporosis are:

* Weight-bearing exercise throughout one's lifetime is one of the most important.
* Adequate calcium, vitamin D, vitamin K, protein, potassium, magnesium, and boron.
* Adequate estrogen levels (for women)

Factors that can contribute to osteoporosis are:

* High sodium and caffeine intake
* Smoking
* Excessive amounts of, or too little, protein

Vitamin D

Vitamin D regulates calcium absorption and excretion, especially when calcium intake is low. Vitamin D deficiency can result in osteoporosis, rickets, and bone pain, and there is evidence that some cases of fibromyalgia are misdiagnosed vitamin D deficiency.

Vitamin D can be made by the action of sunlight (UV rays) on skin. Light-skinned, non-elderly adults exposing their hands and face to sunlight during the summer for 10-15 minutes, 2-3 times/week should get enough vitamin D from sunlight. Extra amounts can be stored for during the winter, however, there is some evidence that these stores are not enough for those living in northern climates.

Vegans who do not get much sunlight exposure should supplement with vitamin D, especially during the winter or cloudy months. Vitamin D is not synthesized during the winter in northern climates.1

Elderly people may need up to 4 times,2 and dark-skinned people may need up to 6 times, the amount of sun listed above in order to meet vitamin D needs through sunshine alone. Thus, it is prudent to take a modest vitamin D supplement or use fortified foods.

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.2 Most Americans get vitamin D through sunshine, fortified milk, and fortified margarine.

Types of vitamin D:

Vitamin D3 - cholecalciferol; is derived from animal foods or made by the action of ultraviolet light on the skin.

Vitamin D2 - ergocalciferol; a plant chemical that has vitamin D activity in humans, but not as much activity as D3; therefore vegetarians who rely on D2 may need slightly higher intakes.2

One small study found an increase in lumbar spine (lower back) bone density in 4 out of 5 vegans in Finland (a northern country where sunlight does not activate vitamin D during the winter) who took 5 mcg/day of vitamin D2 for 11 months.3

The Daily Value for vitamin D is 10 mcg (400 IU). Therefore, if a food label says it has 25% of the daily value, it means it has 2.5 mcg (100 IU) per serving.

Dietary Reference Intake (DRI) for vitamin D
Age (yrs) DRI mcg(b) (IU) Upper LimitA
mcgB (IU)
< 1 5 (200) 25 (1000)
1-50 yrs old (incl. pregnancy) 5 (200) 50 (2000)
51-70 yrs 10 (400) 50 (2000)
Over 70 15 (600) 50 (2000)
A - Do not exceed the upper limit.
B - mcg = microgram = µg

Sources of Vitamin D:

# Typical fortified soy, almond, or rice milk: 2-3 mcg (80-120 IU) per Cup
# Vitamin D-only Supplements:

* Country Life ergocalciferol: 25 mcg (1000 IU) D2 per tablet (can break in half)
Sold in many health food stores.
* Multivitamins containing vitamin D2.

More on Vitamin D: The Forgotten Nutrient

Americans are constantly being urged to consume more calcium in order to prevent osteoporosis. The recommendations have gotten to the point where it is practically impossible to meet them without supplements or large amounts of cows' milk or calcium-fortified foods. At the same time, little emphasis has been placed on vitamin D. That may be changing as more research comes out showing that vitamin D may be just as important, if not moreso, as calcium.

Elevated PTH: A Factor in Osteoporosis

When calcium levels in the blood drop, parathyroid hormone (PTH) is released. PTH causes calcium to be released from the bones, thus raising the low calcium levels in the blood. Osteoporosis may result from chronically high levels of PTH.

What Is Vitamin D?

Vitamin D is the building block of the hormone calcitriol. Calcitriol increases absorption of calcium and phosphorus from the intestines and decreases their excretion in the urine. In so doing, calcium levels in the blood rise and PTH levels drop, preventing PTH from causing calcium to be released from the bones. Over the long term, lower PTH levels should help prevent osteoporosis.

Vitamin D is called cholecalciferol (or vitamin D3) when derived from animal foods or made by way of ultraviolet light on the skin. Another form of vitamin D, ergocalciferol (or vitamin D2), comes from plants. Vitamin D3 and D2 must be modified by the liver and then the kidneys to become calcitriol. This conversion is regulated by PTH levels to some extent.4

Calcitriol has many other functions, including both the breakdown and build-up of bones. It also has effects on other tissues. How the body regulates the processes of conversion of vitamin D into calcitriol and the net increase/decrease of bone calcium are questions still in need of answers. Although we are finding out more all the time, we must proceed cautiously so as not to do more harm than good.

Nurses Health Study: Vitamin D More Important Than Calcium

A new report from the Nurses Health Study (NHS) shows that vitamin D intake through foods and supplements may be more important than calcium intake for preventing hip fractures in postmenopausal women.5 The study included over 72,000 postmenopausal women, 98% of whom were white. The participants' diets were measured repeatedly over the 18 years of follow-up.

There are many factors that contribute to bone health, making it hard to control for variables in studies. For example, while calcium and vitamin D can improve bone health, too much vitamin A (retinol, not beta-carotene) can harm bones. Since milk is often fortified with both vitamins A and D, its effect on bones is difficult to interpret. In the NHS, the researchers used several different models to adjust for many of the variables that can influence hip fractures.

Both dietary calcium (only from food) and total calcium (i.e., food plus supplements) were tested using 6 models for each. Of the 12 models total, only one showed a statistically significant6 protective effect of calcium: total calcium of 1200 mg/day or more, compared to less than 600 mg/day, was associated with a 30% reduced risk of fracture. This result was adjusted only for age.

Vitamin D intake, on the other hand, showed a protective effect in 8 of 12 models. A dietary vitamin D intake of greater than 6.2 mcg/day, compared to less than 2.5 mcg/day, showed a reduced risk of 33-43% in all 6 models tested. A total vitamin D intake of 12.5 mcg/day or more, compared to less than 3.5 mcg/day, showed a reduced risk of 37% in 2 out of 6 models.

The authors discuss some of the clinical trials on vitamin D supplementation and bone health, and note that the results have been mixed. Vitamin D appears to be more important in conjunction with lower calcium intakes (typical in most vegan diets).

The authors conclude, "[W]e observed a significantly lower risk of hip fracture among those with higher vitamin D intakes, whether from food alone or from food plus supplements. Overall, calcium intake did not appear to be associated with fracture risk." Still the authors believe that a steady supply of calcium is needed to ensure bone health (they do not give an exact amount).

Is Sunshine During the Summer Months Really Enough?

The RDA for vitamin D is 5 mcg for people aged 1 to 50, and 10 mcg for people over 50. Most people get vitamin D from fortified milk and fish. The vegan diet contains little, if any, vitamin D without fortified foods or supplements.

While not found in many foods, it is usually assumed that people do not need to worry about vitamin D because they get it from sunshine. For many years it was thought that people who got plenty of sun during the summer could store enough vitamin D to make it through the darker months. However, these days most of us go from our house, to our car, to our office building, back to our car, back to our house. And when we are in the sun, we might be wearing sunscreen. Aging and dark skin reduce the efficiency of vitamin D production via sunlight. In fact, recent research is casting doubt on whether people really do store enough for the winter, especially people living in non-tropical climates.

A study out in 2003 by Heaney et al.7 indicates that male adults in good health, living in Nebraska, and starting with a healthy supply of vitamin D still need about 12 mcg/day of vitamin D during the winter to keep their stores from diminishing. And what may be even more important is that over the course of the winter, PTH levels of the men changed in the following way:

Vitamin D per day PTH change
< 5 mcg rose 6%
25 mcg none
125 mcg none
250 mcg fell 24%

The fact that 250 mcg/day of vitamin D caused PTH levels to drop indicates that these men may not have had ideal vitamin D levels even at the beginning of the winter.

A vitamin D intake of 250 mcg/day is a lot. In fact, the current upper tolerable limit for vitamin D is 50 mcg/day for adults. Heaney et al. state, "[T]he evidence available today indicates that a value of [50 mcg/day] for the tolerable limit level is too low. As already noted, the data presented here indicate an average daily need perhaps twice that much."

In another recent experiment, vegans in Finland were not able to maintain healthy levels of vitamin D or PTH during the winter.8 A follow-up study found an increase in lumbar spine density in 4 out of the 5 vegans who took 5 mcg/day of vitamin D2 for 11 months.3

In the Nurses Health Study described above, vitamin D intake provided the same benefit for those living both in southern and northern climates. This adds evidence that vitamin D should be of concern for women living in any U.S. climate, not just the north.

Vitamin D and Other Diseases

Recently, some research has looked for any connection between vitamin D and diseases not usually associated with it. The research has found that low vitamin D levels are possibly linked with prostate cancer, as well as with fibromyalgia and lupus.

Summary

As mentioned above, calcitriol, has many effects on bones and other tissues. Thus, more research is needed before people start taking large amounts of vitamin D as suggested by Heaney et al. Based on the results above, getting 5 to 12 mcg/day, especially during the winter, seems reasonable, safe, and prudent for optimal health.
Calcium

The Dietary Reference Intake (DRI) for calcium is:

Age mg Upper Limit*
1 - 3 500 2500
4 - 8 800 2500
9 - 18 1300 2500
19 - 50 1000 2500
>50 1200 2500
*Do not exceed the upper limit.

Plant foods high in calcium are:

Food Serving Ca (mg)
cow's milk (for comparison) 1 C 300
typical calcium supplement 1 tablet 300-500
soymilk, fortifiedb 1 C 200-300
tofu (if 'calcium-set') 1/2 C 120-300
orange juice, fortifiedb 1 C 250
blackstrap molasses 1 T 187
collard greensa 1/2 C 178
sesame seeds 2 T 176
veg baked bean 1 C 128
navy beans 1 C 128
kalea 1/2 C 90
tahini 1 T 64
broccolia 1/2 C 50
almonds 2 T 50
a - Cooked
b - Read the label for calcium amounts
T - tablespoon

It is prudent for vegans to try to reach the DRI for calcium on a daily basis. This can be done by getting three servings of a high calcium food as listed above, and using a calcium supplement if needed.

Many non-dairy milks are now fortified with calcium, vitamin D, and/or vitamin B-12. Many orange juices and other juices are fortified with calcium.

Shake calcium fortified non-dairy milks before pouring as the calcium can settle on the bottom.

The calcium in kale, broccoli, collard greens, and soymilk is absorbed about the same percentage as that in cows' milk.

The calcium in spinach, Swiss chard, and beet greens is not well absorbed, due to their high content of oxalates, which bind calcium.

Plant foods that provide calcium offer other nutrients that are good for bones: vitamin K in leafy greens; vitamin C, potassium, and magnesium in calcium-fortified orange juice; boron in beans, nuts, leafy green vegetables, and non-citrus fruits.1

Calcium supplements can inhibit iron absorption if eaten at the same time.4

The Daily Value for calcium on food labels is 1,000 mg. Therefore, if a food label says it has 25% of the daily value, it means it has 250 mg of calcium per serving.