Has the Daily Mail Exposed the 'Vegan Diet Con'?
(No.)

In November 2022 the Daily Mail published an article titled "The great vegan diet 'con': How a plant-based lifestyle is NOT always better for your health - and could lead to brittle bones, anemia and hair loss".

Claim

"To achieve the impossible task of making bland vegetables or tofu credible substitutes, food makers often have to cram them full of unhealthy oils, starch and other ingredients high in saturated fat, sugar and salt."

Response

It's true that some plant oils, like coconut and palm oil, are high in saturated fat and can increase cardiovascular disease (CVD) risk. However, most of the oils used in plant-based meat and dairy alternatives are healthy. In fact, most vegetable oils are rich in polyunsaturated fatty acids , which, when replacing saturated fats (the kind common in meat), consistently reduce CVD risk.(S)

To claim animal product alternatives are high in saturated fat is ridiculous. A 2021 UK study(S) analyzed 200+ plant-based meats (PBM), and 200+ meat products, the results were as follows:

"Compared to meat, PBM had significantly lower energy density, total fat, saturated fat, protein, and significantly higher fiber. Salt content was significantly higher in five out of six PBM categories. Based on the UK’s Nutrient Profiling Model, 14% of PBM and 40% of meat products were classified as “less healthy” (p < 0.001). When considering the UK’s front-of-pack labelling criteria 20% of the PBM and 46% of meat products were considered high in either total fat, saturated fat, or salt (p < 0.001)."

As for sugar, the sugar content of both product groups was very low, so the study didn't bother to analyze it. Beyond meat, for example, doesn't have any sugar.(S) It is important, though, that meat alternative companies work toward reducing the sodium content of their products.

Claim

"Yet studies in the years since have shown vegans are much more likely to suffer from a calcium deficient diet than meat-eaters — putting them at greater risk of brittle bones and an energy deficit.

The human body needs about 1,300 milligrams (mg) of calcium per day to maintain healthy bones, which most get from yoghurts, cheese and milk."

Response

While these are the recommendations in some other countries, the United Kingdom, where the Daily Mail is published, recommends a minimum of 700 mg/d of calcium. The UK's recommendations actually appear to be more in line with the evidence.(S) And vegans tend to consume more than 800 mg/d.(S)

Claim

"But vegans must rely on broccoli, spinach and rye bread — which they need to eat in unmanageable amounts — to get enough of the mineral."

Response

These are preposterous examples. An 150 g serving of extra-firm tofu provides 560 mg of calcium—already most of the daily requirement. A cup of Silk soy milk can provide 450 mg of calcium, 4 tablespoons of chia seeds 250 mg, and a cup of cooked spinach 240 mg. Many other foods also contribute small amounts that can add up, such as beans (60-120 mg depending on type), and almonds (70 mg per ounce). Calcium from broccoli may also contribute to your intake, but implying it's one of vegans' best sources is ridiculous when it only provides 60 mg in one chopped cup. And rye bread? It has 36 mg in two slices. They clearly cherrypicked the absolute worse sources of plant-based calcium to support their narrative.

Claim

"Vegans are more than twice as likely to suffer a hip fracture, ankle injury or other bone damage on their leg, a study from 2020 warned."

Response

In this study, BMI and dietary calcium were adjusted for, but only via categorisation, which is known to bias results when examining continuous variables with non-linear responses.(S) Additionally, the study did not adjust for or even consider Vitamin D status or intake. Not to mention, when the researchers only looked at those with a BMI over 22.5, the increased risk of bone fractures in the vegans completely disappeared.

Claim

"They were consuming nearly half the amount of daily calcium as meat eaters, having about 611mg a day compared to 1,058mg among meat eaters."

Response

Yet vegans typically do consume enough as indicated by the earlier reference.(S) In fact, in one Finnish study (with precise measurements of dietary intake), vegans consumed over 1000 mg/d, which is compliant with US recommendations.(S)

Claim

"Scientists behind the research believe a lack of calcium consumption was behind the higher risk of fractures among vegans. 

They also pointed the finger at rapid weight loss — a cited benefit of veganism. 

 They said that losing weight would leave less 'cushioning' for bones when someone falls, raising the risk of a fracture. They also said that being lighter means bones need to carry less weight, leading to them being weaker."

Response

Cool, these aren't inherent aspects of a vegan diet and therefore are only an argument against inadequate iterations of a vegan diet rather than vegans as a whole.

Claim

"Another paper from 2022 warned vegetarian women had a higher risk of breaking their hips later in life compared to meat-eaters."

Response

This study adjusted for calcium intake, Vitamin D intake, and protein intake separately instead of at once in one model; we don't know how the results would look with a combined calcium + Vitamin D + protein model. Not to mention that when the researchers only looked at those with a BMI over 23.5, the increased risk in vegetarians disappeared.

Claim

"Some 6.6 per cent of vegans suffer from anemia, a 2019 study suggested, double the 2.9 per cent of meat-eaters that had the condition. Among vegetarians the rate was 3.9 per cent."

Response

6.6% is still low, once again illustrating these concerns to not be inherent aspects of a vegan diet. Consuming more iron and increasing bioavailability through a number of methods including consuming Vitamin C-rich foods with meals can help iron deficiency anemia. Meanwhile B12 anemia may be averted via supplementation.

Claim

"Another paper from 2016 also warned that vegans need to ensure they get enough nutrients, after finding adherents of the diet were more likely to suffer from borderline anemia than meat-eaters."

Response

This happens to be the aforementioned Finnish study that found high calcium intake in vegans. The same reasoning from the above response applies here as well.

Claim

"Red meats including beef, lamb and pork as well as liver, poultry and salmon are rich in iron and vitamin B12. 

But vegans will need to eat copious amounts of lentils, chickpeas, tofu and fortified cereals to meet their daily recommended intakes."

Response

Vegans literally consume MORE iron then meat-eaters.(S) Obviously the problem is that absorption is lower, but arguing that intake is lower too in an attempt to make getting enough iron seem even harder is ridiculous.

Claim

"They are also at higher risk because the iron in plants is not as easily absorbed by the body as the iron in meat, meaning they will need to consume more."

Response

Heme iron, found in meat, is very consistently absorbed, while non-heme iron, found in plants, varies in its bioavailability. This, however, can be overcome by consuming Vitamin C-rich foods with meals, which significantly boosts non-heme iron absorption.(S) And vegans on average do tend to have adequate iron status.(S)

Claim

"A fifth of vegans are already thought to be deficient in vitamin B12, according to a 2019 study, which doctors warn leaves them at risk of irreversible nerve damage that could result in numb hands and feet."

Response

Cool, google "supplement."

Claim

"But a British study involving 48,000 people — including 16,000 vegans — found there were three more cases of stroke per 100,000 people among vegans compared to meat-eaters."

Response

In this study, vegetarians & vegans had a lower risk of heart disease (10 fewer cases per 1000 people) but higher risk of stroke (3 more cases per 1000 people). Unsurprisingly, the Daily Mail only mentioned the stroke. Also they say "among vegans" which is false as the study combined vegetarians & vegans as one group. 

Age is a big risk factor for hemorrhagic stroke, which was the subtype of stroke that the vegetarians in the study had a higher risk of. Since the vegetarians in the study were less likely to die from heart disease, and therefore lived longer, they were reaching the ages where hemorrhagic stroke is more common, explaining the results. When they limited the analysis to those who had an event before the age of 70, the increased risk of stroke for the vegetarians disappeared. And most importantly, citing the study to support an association between vegetarianism and strokes is utter cherrypicking, as overall the research on the topic has overwhelmingly found no association or even limited evidence of a reduction in risk.(S)

Claim

"The jury is still out on whether a vegan diet raises someone's risk of suffering stroke, with experts saying more studies are needed to shore-up the findings."

Response

The jury isn't out when the evidence overwhelmingly finds the opposite and the study in question failed to adjust for a crucial factor.

Claim

"There are anecdotal reports that vegan's are more likely to suffer hair loss than people who eat meat, although the hypothesis is yet to be backed up by any rigorous scientific studies. 

Dr Anabel Kingsley — a scalp health expert — previously said, however, that as hair is not an 'essential tissue', when there is a deficiency of key nutrients the body may discard it. 'If you're not eating enough of the correct foods or your body is not absorbing enough of the nutrients, this can result in excessive shedding,' she told the Insider. 'Even if you're only slightly deficient in a nutrient, the body withholds this from the hair first.' 

Loss of hair linked to veganism is temporary scientists say, with the lost strands returning once the nutrient deficiency subsides. This differs from baldness, which is caused by changing testosterone levels.

Hair is made of keratin, which is made from several different proteins found in animal tissue. 

A vitamin B12 or iron deficiency could also trigger hair loss, scientists argue, because the anemia it causes would lead to too little oxygen getting to areas like the scalp. 

This may lead to hair follicles being unable to regrow lost hairs, leading to balding."

Response

So a vegan diet might cause hair loss because you said so? You admitted you have no evidence to back it up, so why mention it?

Claim

"One study published this year which surveyed 14,000 Brazilians between 35 and 74 years old found those who followed a vegan diet were twice as likely to be depressed — even if they had similar nutrient intakes to carnivores. 

A meta-analysis published in 2020 and including 160,000 meat-eaters and 8,500 meat-abstainers also found those who cut meat from their diet were significantly more likely to be depressed."

Response

Yet a newer systematic review on the topic revealed the evidence to be so poor and incosistent that making a claim in either direction is absurd.(S) A total of 25 study outcomes (23 individual publications) were included. Just 44% of studies found plant-based diets to be associated with depression. The other 56% were equally split between studies finding BENEFICIAL effects on depression and studies finding no effect at all. Yet, the quality of evidence was rated as ‘good’ in only FOUR out of 23 studies. One of these four found a higher risk for vegetarians in one population with no risk in another, and all the other three found a LOWER risk of depression. Iffffff anything, a vegan diet reduces the risk of depression.