Plant-Based Diets & Sweetened Beverages Cause Bone Loss

Several factors impact bone density, such as age, ethnicity, sex, weight, physical activity level, digestion, use of acid blocking and steroid medications, autoimmune diseases, and eating disorders, etc. 

Furthermore, two dietary trends, plant-based diets and sugar sweetened beverages, can lead you down a path of bone loss if you are not careful. With one or more of these factors, you may face a decision to use osteoporosis drugs to treat bone loss. Are your dietary choices giving you the support you expect or hurting you?   

Plant-Based Diets and Bone Loss

The modern trend is to push the global population towards plant-based diets such as vegan, vegetarian, fruitarian, etc. While these diets may seem healthier for some things, they may not always provide all the essential nutrients for bone density and overall health. 

Poorly informed or impaired implementation of a quality plant-based diet can lead to multiple nutrient deficits in the unsuspecting individual. Moreover, anti-nutrients like phytates, tannins, lectins, and oxalates found in plant-based foods can compete against the absorption of several nutrients, depending on food-preparation. These results can lead to impaired bone density and quality. 

A recent systematic review and meta-analysis study published in the Nutrition Review journal highlighted the concerns of vegetarian and vegan diets for bone health. The study criteria evaluated 37,134 participants from 20 studies. It was found that participants who consumed vegetarian and vegan diets had decreased bone mineral density of the hip bone/femoral neck and lumbar spine/low back. Vegans had higher rates of bone fractures of various types. 

Other studies raise concerns about plant-based diet lifestyles and bone density. Results from the UK Women’s Cohort Study evaluated the risk of hip-fractures in various diets. They also found that vegetarians incurred more hip-fractures than occasional or regular meat eaters. 

A recent 2022 study compared the bones of healthy adults on plant-based versus omnivore diet. They used several measurements such quantitative CT scans, blood tests, diet and nutritional measurements, and strength training questionnaires to assess participants bone density and health.   

The results showed vegans had altered bone density of the cortical (outer) and trabecular (inner) structures compared to omnivores. However, those individuals who participated in strength training and consumed a well-planned diet had similar bone micro-architecture as the omnivore participants. 

Think about the dietary ramifications of the adolescent who has given up meat and decides to consume veggie straws, pop tarts, cheerios, PB& J sandwiches, and almonds as their plant-based diet. How about a plant-based diet such as breakfast with bagel and latte, a salad for lunch, and then ramen noodles, chips and salsa for dinner. Does this sound like anyone you know? Are these meals nutrient-dense and able to meet the needs of your bones and whole body?  

Plant-based diets need to be implemented with care as nutritional deficits are present even with the best intentions. The goal for all individuals is to be mindful of the strengths and weaknesses of any diet and address the weaknesses with dietary changes and nutritional supplementation.    

Sugar Sweetened Beverages 

Another dietary concern that markedly affects bone health is chronic consumption of sugar sweetened beverages. More than 80% of the United States population consumes more than 360 calories per week of sugar sweetened beverages, which is more than what is recommended by the American Heart Association. Generations have consumed sugar sweetened beverages for decades that cause bone loss and affect many other aspects of health. 

The definition of a sugar sweetened beverage is any consumable non-alcoholic water-based beverage containing significant amounts of added sugars. This includes non-diet soft drinks/sodas, flavored juice drinks, sports drinks, sweetened waters, coffee, tea, hot chocolate, and dairy or non-dairy milk with added sugars, energy drinks, and electrolyte replacement drinks. 

Sugar Sweetened Beverages Affect the Bones of All Ages 

Results of a very large systematic review and meta-analysis found evidence of decreased bone density throughout the whole skeleton in adolescents, young, and middle-aged adults who consume sugar sweetened beverages. The older the individual, the greater the percentage bone loss occurred. 

Changes in Just Days 

Bone density changes can happen in just days with dietary challenges. This was seen in a study with healthy young men (22-29 years) that evaluated bone density and diet. In the first phase of the study, men consumed a low calcium basic diet with 2.5 liters of Coca Cola per day for ten days. A 10-day break followed. In the second phase of the experiment, the participants consumed 2.5 liters of low-fat milk per day with the same low calcium basic diet. 

Several blood tests were obtained during the study measuring bone turnover, vitamin D loss, parathyroid hormone, etc. Results showed that during the 10-day Coca Cola period and low calcium diet, there were significant changes with bone loss. Bones were metabolically stressed more so than with a low calcium diet. 

Sugar, Phosphate, Caffeine, Carbonation, Acidity – Oh My!

Sugar is a great metabolic disruptor for bone metabolism and causes bone loss. It pulls calcium from bones which is then lost in the urine. Excess and chronic consumption of sucrose, glucose, fructose, high fructose corn syrup, acidic beverages , caffeine, carbonation, and phosphorous have been found to interfere with bone health as these compounds disturb the alkaline pH of tissues and disrupt mineral and hormonal metabolism. 

Meta-analysis review studies have found a direct inverse relationship with bone density and sugar sweetened beverages, i.e. chronic consumption, especially several times per week leads to unhealthy bones. 

Cola Beverages – Ouch!

Cola beverages differ from most other soft drinks/sugar sweetened beverages as they contain phosphoric acid. This is especially problematic with loss of bone density and as it significantly interferes with the absorption of calcium and causes further metabolic loss of this mineral. 

The Framingham Osteoporosis Study found that even one (regular, decaffeinated, or diet) cola beverage per day caused an average of 4-5% loss of bone density in the hips compared to those who consumed only one serving per month. This study included men and women ages 29-86 years with a calcium intake of 800-1000 mg/day. 

Age and Bone Health Decline

By the age of 50, the lifetime risk of a fracture from bone loss in women is 50% and 20% in men. Women over the age of 50 have more than four times higher rate of significant bone loss than men. The prevalence increases each decade. Men ages 70 years and older and women 65 years and older have similar rates of bone loss.

Bone density in adolescents and young adults can also be of concern. A lack of a wide variety of foods and foods that stress bone metabolism places these individuals at risk of increased fractures. I know of individuals who have consumed soft drinks daily starting in preschool and have had numerous fractures throughout their life. Are you prepared for broken bones and a lifetime of compromised health if you are unwilling to reduce or eliminate these types of beverages? 

Think about your lifetime intake of sugar-sweetened beverages. How about the teenagers in your life? Up to 90% of bone mass develops during childhood and adolescence, yet teenagers often consume large amounts of sugar sweetened beverages with the nutrient-poor Western diet. What are the short-term and long-term effects of these beverages combined with a compromised plant-based diet? 

Additional resources: 

Bone Health

Tips for Strong and Healthy Bones

Bone Health Depends on Calcium, Team Player Nutrients and Gut Flora 

Sugar, Not Salt, Harms Bones and Strips Out Minerals