Benefits of a Vegetarian Diet for Older Women

Are there health benefits for a vegetarian diet for older women? Yes, science shows that vegetarian–even a vegan diet for older women may be healthful and beneficial. The key is creating an optimal eating plan to meet your needs.

You’ve probably heard it before, “A vegetarian diet for older women isn’t safe. And a vegan diet for older women is even more risky.” The assumption that plant-based diets aren’t appropriate for women as they age can be a common concern, even among health care and nutrition professionals. Yet it hasn’t kept older women—even celebrities such as Michelle Pfeiffer and Christie Brinkley—from flocking to plant-based diets, such as vegetarian and vegan diets. According to a 2022 survey by Cornell University, about one in ten Americans over the age of 18 considers themselves vegetarian or vegan. Women aged 35 to 54 make up a growing seven percent of that number, and women older than 55 make up more than two percent, but it’s on the rise. And I see this every day in my work as a plant-based dietitian. Quite simply put, more and more older women are seeking out plant-based diets for health benefits. But are these diets indeed healthful for women as they age? 

It’s true that older women have important nutrition concerns, such as maintaining a healthy weight, protecting bones, and warding off heart disease. But that doesn’t mean a plant-based diet is off limits. In fact, this style of eating may be beneficial in dealing with these concerns. The Academy of Nutrition and Dietetics (The Academy) reported in its 2016 position statement on vegetarian diets that appropriately planned a vegan and vegetarian diet are healthful and nutritionally adequate, and they may provide health benefits in the treatment of certain diseases during all stages of the life cycle.

“There’s no reason at all why women of any age can’t adopt a vegan or vegetarian diet,” says Virginia Messina, MPH, RD, a plant-based nutrition expert who specializes in diets for older women and coauthor of Vegan for Her and Never Too Late to Go Vegan. “Some nutrient needs change with age, but those needs can be met from plant foods,” Messina explains. 

Potential Health Benefits for Older Women

Research supports the health benefits of plant-based diets. Vegetarian dietary patterns have been linked with numerous health benefits, including a lower risk of ischemic heart disease, hypertension, cancer, and type 2 diabetes, lower levels of LDL cholesterol and blood pressure, and decreased BMI. In the landmark Adventist Health Study-2 (AHS-2), data on different dietary patterns—vegan, vegetarian, pesco-vegetarian, semi-vegetarian, and non-vegetarian—were analyzed from more than 73,300 Seventh-day Adventist participants in the United States and Canada. According to Ella Haddad, DrPH, MS, RD, an associate professor in the department of nutrition at Loma Linda University School of Public Health, who evaluates data in the AHS-2, “For heart disease—the No. 1 killer in women—the risk seems to be lower among vegan and vegetarians, according to the AHS-2.”

“In some cases, vegetarian women may have nutrient intakes that lower their risk for chronic disease,” says Messina, who also provides nutrition resources on her website, VeganforHer.com. According to Reed Mangels, PhD, RD, LDN, a plant-based nutrition expert, author, and nutrition advisor for The Vegetarian Resource Group, “In terms of heart health, vegan diets are free of cholesterol, and depending on food choices, a vegan and vegetarian diet can be low in saturated fats.”

In another study analyzing data from both men and women enrolled in the AHS-2, researchers linked lacto-ovo vegetarian diets with a 9% reduction in all-cause mortality and vegan diets with a 15% reduction compared with nonvegetarian diets, although the findings were more robust for men than women. In the EPIC-Oxford study, researchers found a 22% lower risk of ischemic heart disease among vegetarian adults (men and women combined) compared with nonvegetarians.

One of the main advantages of a well-planned plant-based diet is its rich nutrient profile, which may be even more important for older women. “Vegetarians eat more fiber and less saturated fat and have diets that are richer in antioxidants, so there are some definite advantages to eating this way as we age,” Messina says.

It can be challenging for older women to navigate and meet their nutritional needs as energy needs tend to decrease with aging, which means that eating a nutrient-dense diet is especially important, says Mangels. “This means that in some ways, a whole-foods vegan or vegetarian diet may actually make this easier because of the many nutrient-dense foods that are often included. Women can eat very well on a nutrient-dense vegan or vegetarian diet without feeling deprived,” Mangels says. Plant-based diets, vegan diets in particular, are associated with lower BMI. A plant-based diet may help women meet their nutritional needs while avoiding weight gain and its cascade of health problems, which may occur as a result of higher body fat.

Meeting Protein Needs

One of the greatest challenges for older women on plant-based diets may be adequate protein intake, especially in light of recent recommendations to increase protein intake while aging. Decreases in total body protein can lead to increased frailty, impaired wound healing, and decreased immune function. A protein intake moderately greater than the Recommended Dietary Allowance (RDA) of 0.8 g/kg of body weight may be indicated to enhance muscle protein anabolism and decrease muscle mass loss. According to the 2016 Position Paper on vegetarian nutrition for older adults, some evidence suggests protein is used less efficiently with aging, which may mean higher protein requirements. 

“Protein is a nutrient that needs some attention in the diets of all older people, since it’s so important for maintaining muscle and bone mass,” Messina says. “Vegetarians, and in particular vegans, may have somewhat higher protein needs compared to people who eat meat. It’s not at all difficult to get enough protein, but vegans do need to put a little bit of extra emphasis on legumes, making sure they consume at least four servings per day. Some older vegans may do better with even a little more than that.”

“The AHS-2 found that those with higher protein intake had better bone density, no matter where the protein came from,” Haddad adds.

Messina suggests that it’s important to choose protein-dense foods, particularly those that are high in the amino acid lysine. “These are legumes, such as beans, soyfoods, and peanuts. Most older women will need at least four servings of these foods each day. It’s not hard to consume that amount, since a serving is just 1/2 cup of beans, tofu, or soymilk or 2 tablespoons of peanut butter. But it does mean that some women may need to emphasize legumes over grains,” she adds. Learn more about getting protein on a plant-based diet here. 

Bone Protection, Calcium, and Vitamin D

Another important concern among older women—vegetarians and nonvegetarians alike—is bone mass preservation (read my blog on bone health for vegans here). Osteoporosis affects an estimated 200 million women worldwide—and approximately one in three women over age 50 will experience osteoporosis fractures, according to the International Osteoporosis Foundation. Some dietary factors, such as calcium and vitamin D intake, which typically are associated with dairy foods, are important for bone health and may be a bit challenging to get in vegan diets. However, plant-based diets can be rich in other key nutrients involved in bone health, such as vitamin K and magnesium.

Are vegetarians—especially vegans, who avoid dairy products altogether—at a greater risk of osteoporosis? “Older vegan women need to put some emphasis on calcium-rich foods, since calcium needs increase with age,” Messina says. “And women are at higher risk of bone loss.” According to Mangels, some studies point out the risk of lower bone mineral density among vegetarians and vegan women, but the evidence is complicated.

According to Mangels, there are only a limited number of studies on bone health in older vegetarian and vegan women. “Most are very small, and several had subjects where both vegan and nonvegan subjects had low intakes of calcium, below 400 mg/day. Although these studies tend to find lower bone mineral density in vegans, I don’t think there has been a study published that has had an adequate sample size and that focused on Western vegans and measured bone mineral density,” she explains. 

When it comes to bone health, it may be more effective to look at a person’s individual nutrient intake rather than generalizing a dietary pattern. For example, a poorly planned vegan diet can be inadequate as far as protein, calcium, and vitamin D and put an older woman at risk of osteoporosis, just as a nonvegetarian diet can. To support bone health, Mangels recommends “adequate protein—at least meeting the RDA of 0.8 g/kg/day and possibly going somewhat higher, since higher protein intakes along with exercise have slowed the loss of muscle mass that occurs with aging. An intake of 1 to 1.2 g/kg/day of protein seems reasonable.” As for calcium, she recommends meeting the current RDA of 1,200 mg/day of calcium for women aged 51 and older.

To achieve adequate levels of calcium and vitamin D, vegetarian women can follow the USDA MyPlate recommendations, which call for three servings of low-fat or fat-free milk, yogurt, and other dairy products as well as calcium-fortified foods and beverages. Vegan women can replace these dairy servings with other calcium-rich foods and beverages. “For vegans, calcium-rich foods are fortified plant milks, fortified juices, tofu made with calcium sulfate, and leafy greens such as collards, turnip greens, kale, and bok choy,” Messina says.

Vitamin D is found in fortified plant milks, and vegan women are encouraged to get 10 to 15 minutes of sunlight exposure per day. “The AHS-2 showed that vitamin D status was best for people that lived in areas with more sunshine; it was not as dependent on diet,” says Haddad, who stresses that getting adequate vitamin D is important. Mangels suggests meeting the current RDA for vitamin D, which is 600 IU/day for women aged 51 to 70 and 800 IU/day for women older than 70.

Plant-Based Omega-3 Fatty Acids

A body of evidence indicates that omega-3 fatty acids may have numerous potential health benefits, including preventing heart disease and stroke, aiding against rheumatoid arthritis, and protecting against Alzheimer’s disease and cancer. The intake of marine omega-3s—EPA and DHA, which come mainly from fish—may be low in vegetarians and vegans who avoid fish altogether. However, alpha-linolenic acid (ALA), a common plant-based omega-3 fatty acid found in vegetable oils, walnuts, flaxseeds, and leafy vegetables, can be converted to EPA and DHA in the body, though at low levels.

While several studies have found that EPA and DHA levels are lower in vegetarians and vegans than in nonvegetarians, Haddad reports that the AHS-2 revealed more positive findings. “Omega-3 levels—EPA, DHA, and ALA—in the body were good among vegetarians and vegans in AHS-2,” she says, adding that she believes health care professionals should encourage adequate intakes of ALA, EPA, and DHA in this population, although she warns against “going overboard” with them.

While getting enough ALA may be easy, as it’s found in many foods that appear on the typical plant-based menu, EPA and DHA may be more elusive for vegetarians and vegans. However, the rising availability of marine algae supplements containing EPA and DHA has made it easier to get these healthful fats. “The need for supplements of DHA and EPA continues to be controversial. But conversion of ALA to these long-chain omega-3 fats may be less efficient in older people, so it may be a good idea to take a small daily supplement providing 200 to 300 mg of DHA and EPA combined,” Messina suggests. Learn more about plant-based omega-3 sources here. 

Vitamin B12 Boost 

Just as important as meeting the required intake of omega-3s through diet is maintaining adequate levels of vitamin B12. It plays a major role in metabolism, red blood cell formation, central nervous system maintenance, and DNA creation. Vitamin B12 deficiency is serious, as it may result in megaloblastic anemia, with symptoms that include numbness in the arms, difficulty walking, memory loss, and disorientation.

But this essential nutrient is found specifically in animal products, such as fish, meat, poultry, eggs, milk, and other dairy products; it’s generally not found in plant foods. Though vitamin B12 is available in fortified foods, it’s recommended that vegans supplement their diet with a daily vitamin B12 supplement. However, even nonvegetarian older women should be concerned about vitamin B12, as older adults may have impaired absorption of this nutrient and suffer from deficiency. Thus, the Institute of Medicine recommends that all adults over the age of 50 receive most of their vitamin B12 through supplements and fortified foods.

“Many older adults have difficulty with absorbing vitamin B12 from meat and dairy products but are able to absorb vitamin B12 from fortified foods and/or supplements,” Mangels says.

Haddad reports encouraging findings from the AHS-2: “Most of our population was eating foods that were fortified with vitamin B12, taking a vitamin B12 supplement, or both. I didn’t see that there was a big problem with vitamin B12 deficiency among older women on vegetarian or vegan diets.” Learn more about B12 on plant-based diets here. 

Finding Balance 

When you look at the evidence on plant-based diets for older women, vegetarian and vegan diets can provide health benefits or potential risks, but this depends on how appropriate and well planned the diet is. As with any diet pattern, it’s possible to skip key nutrients, such as calcium and vitamin D that are essential for health, or overload on unhealthful nutrients such as refined carbohydrates and sodium, which may be detrimental to health. However, a balanced plant-based diet—rich in legumes, whole grains, vegetables, fruits, nuts, seeds, and healthful fats—offers all of the foods that are linked to optimal health. “It really is important for postmenopausal women to eat a very nutrient-dense diet by including plenty of vegetables in meals and limiting ‘discretionary’ calories from sweets, snack foods, and alcohol,” says Messina. “It doesn’t mean you can never have these foods, but putting the emphasis on whole plant foods becomes increasingly important. And including plenty of exercise in your routine will allow you to consume more calories, which in turn helps with meeting nutrient needs,” she says.

For other blogs on planning a healthful plant-based diet, check out the following: 

How to Get Vitamin B12 on a Vegan Diet
How to Get Choline on a Vegan and Vegetarian Diet
How to Power Up on Plant Proteins
Get Your Omega-3s the Plant-Based Way
Meeting Your Nutrient Needs on a Vegan Diet

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