The role of low acid load in vegetarian diet on bone health: a narrative review

Swiss Med Wkly. 2016 Feb 22:146:w14277. doi: 10.4414/smw.2016.14277. eCollection 2016.


Vegetarian and vegan diets contain low amounts of protein and calcium. For this reason they are supposed to cause low bone mineral density (BMD) and osteoporosis. But this is not the case, except for vegans with a particularly low calcium intake. The absence of osteoporosis or low BMD can be explained by the low acid load of these diets. Nutritional acid load is negatively correlated with bone mineral density (BMD) and positively with fracture risk. Low acid load is correlated with lower bone resorption and higher BMD. It is linked to high intake of potassium-rich nutrients, such as fruits and vegetables, as found in vegetarian diets. The total nutritional acid load, which not only depends on the potassium content of the nutrition, was recently assessed in several studies on vegetarian and vegan diets and was found to be very low or absent, while the diet of Western-style omnivores produces daily 50 to 70 mEq of acid. This might be an important factor for the protection of vegetarians from osteoporosis.

Publication types

  • Review

MeSH terms

  • Acids / metabolism*
  • Bone Density*
  • Bone Diseases, Metabolic / epidemiology
  • Bone Diseases, Metabolic / metabolism
  • Bone Resorption / epidemiology
  • Bone Resorption / metabolism
  • Diet, Vegan / statistics & numerical data
  • Diet, Vegetarian / statistics & numerical data*
  • Fruit
  • Humans
  • Osteoporosis / epidemiology
  • Osteoporosis / metabolism*
  • Potassium, Dietary / metabolism*
  • Protective Factors
  • Vegetables


  • Acids
  • Potassium, Dietary