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Atlantico.fr: According to a large study conducted in the UK and published in BMC Medicine, vegans – vegans – have an increased risk of fracture of the bones and in particular of the hips, an excess risk not observed in vegetarians. Is this an important discovery?
Beatrice de Reynal: There is little work and therefore, limited prospective evidence on possible differences in fracture risks between vegetarians, vegans and non-vegetarians. Previously, epidemiologists’ fears were that certain exclusion diets would be very detrimental to the health of subjects, especially those who had no meat, which means a deficiency of iron, zinc, at least vitamin B12 and even no milk and dairy products, which means a lack of calcium and, very often, at least vitamin D.
Veganism – I don’t eat anything animal, not even honey – implies that subjects lend themselves to significant deficiencies mainly in micronutrients, as proteins, for their part, are readily available in classic vegetable sources such as cereals, legumes, seeds and dried oily fruits.
But it is quite different for the minerals mentioned. If you can actually find calcium in cabbage, you need to eat several kilograms a day to meet your daily needs. Ditto for iron, of which we have long known that vegetable iron is very little assimilated and even bioavailable.
So vegans have historically been warned against iron deficiency – especially for women, especially when they are of childbearing age or pregnant – and for children. To the point that we have even formally advised against parents imposing a vegan diet on their very young and old children.
Everyone remembers this vegan couple who lost their babies to malnutrition for giving sugar water instead of milk, which they thought was bad.
A recent study sought to look at these possible differences within EPIC OXFORD, a potential cohort with a large percentage of non-meat eaters. Nutrition information was collected at baseline and during follow-up.
Participants were classified into four diet groups: 29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians, and 1,982 vegans. Follow-up was operated from 1993 to 2010 and patient follow-up continued until 2016.
The researchers highlighted the number of total fractures. The total (n = 3941) and specific limb risks (arm, n = 566; wrist, n = 889; hip, n = 945; leg, n = 366; ankle, n = 520; other major sites, i.e. collarbone , rib and vertebra, n = 467) were identified by dietary group.
Compared to meat eaters and after adjusting for socioeconomic factors, lifestyle and body mass index (BMI), the risk of hip fracture was higher in fish eaters (hazard ratio 1.26) , vegetarians (1.25) and especially vegans (2.31), which is equivalent to differences in risk rates, respectively of 2.9, 2.9 and 14.9 more cases per 1,000 people over 10 years.
Vegans also had a higher risk of total (1.43), leg (2.05), and other main site fractures (1.59) than meat eaters.
Overall, significant associations appeared to be stronger without adjustment for BMI and were slightly attenuated but remained significant with additional adjustments for dietary calcium and / or total protein. There was no significant difference in the risk of wrist or ankle fractures or arm fractures.
Non-meat eaters, particularly vegans, had a higher risk of total fractures or some specific fractures, such as the hip.
And does the vegan diet create these risks?
Who says fracture or bone quality. However, we know that bone is made up of equal parts of calcium and phosphorus, all solidified by fluorine. To assimilate calcium, and to fix it in the bone, we need vitamin D, a vitamin almost exclusively of animal origin: oily fish (sardines, mackerel, tuna) and fat (salmon, herring, etc.), egg yolk, livers of all kinds (fish or terrestrial animals) and animal fats in general (butter, fatty cheeses, etc.). Although vegan vitamin D from seaweed can be found on the market in the 21st century, this was not the case at the time of the study. The sun allows the synthesis of vitamin D through the skin, but not at all ages or in all seasons.
Furthermore, there are many physiological conditions necessary to create bone and increase its calcium mass: not only do you have to move and exercise, you must have enough protein rich in essential amino acids and a few others. relevant nutrients such as iron, zinc, copper trio. So many nutrients that are in abundance in meat products. This explains why fish eaters have a lower status than the meat magner. Fish is less rich in iron, in particular.
If this diet is associated with increased bone risk, are vegans able to fill the deficiencies that cause them these problems?
Vegans will therefore have to adopt a nutritional strategy that is more relevant and appropriate to their age, their geographical location (sun) and their lifestyle. Vegans already know that they absolutely must be supplemented with vitamin B12. They will undoubtedly have to pay much more attention to their status in these minerals, trace elements and vitamin D which appear to be severely deficient. These findings suggest that bone health in vegans requires more research and more relevant management.
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