In light of a recent meta-analysis in which vegans had a higher risk of rectal cancer, we reinforced our recommendation that vegans should aim to meet the RDA for calcium; see Cancer Meta-Analysis (Another One!). To ensure this guidance was well-founded, I reviewed the strength of the evidence connecting higher calcium intakes to reduced colorectal cancer risk. Here’s the summary:

Higher calcium intake — ideally around 1,000 mg/day — is consistently associated with lower colorectal cancer risk in observational studies, and the World Cancer Research Fund rates the evidence for causality as “probable.” Randomized trials have been largely disappointing, however, possibly because they’re too short to capture a process that unfolds over decades or because participants already have adequate calcium intakes at baseline. For vegans, who often fall below 700 mg/day, aiming for closer to 1,000 mg/day is worth prioritizing for bone health and could also protect against colorectal cancer.

See the details in Calcium and Colorectal Cancer.

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As promised in my March 6 post, Cancer Meta-Analysis, I conducted a literature review of long-chain omega-3s (EPA and DHA) and colorectal cancer. Here’s my summary:

Given these findings, I don’t see a reason to recommend long-chain omega-3 supplements for vegans in order to prevent colorectal cancer. More details are in the article, Omega-3s and Colorectal Cancer.

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I made a quick update to the Infants section of Pregnancy, Infants, and Children:

A study of over 1.2 million infants, including 3,338 vegans, found normal growth among the vegan infants (Avital, 2026, Israel). Vegan babies were on average about 100 grams (3.5 oz) lighter at birth (3.2 kg / 7 lb 1 oz vs. 3.3 kg / 7 lb 4 oz) and more likely to be born small for their gestational age (11% vs. 6.6% of omnivore babies). By age two, vegans had caught up and differences in weight, length, and head circumference were clinically insignificant.

Reference

Avital K, Fliss-Isakov N, Shahar DR, Blaychfeld-Magnazi M, Ben-Avraham S, Tepper S, Hamiel U. Growth Trajectories in Infants From Families With Plant-Based or Omnivorous Dietary Patterns. JAMA Netw Open. 2026 Feb 2;9(2):e2557798.

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Two 2026 meta-analyses (released in one month of each other) reached different conclusions about vegans and colorectal cancer. Here are the differences.

Dunneram et al. conducted a pooled analysis using individual participant data from 9 cohorts comprising 1.8 million people and 220,387 incident cancers, with a median 16-year follow-up. Aune et al. conducted a more traditional aggregate meta-analysis, combining published summary estimates from 7 cohorts. Dunneram applied false discovery rate (FDR) correction across 16 associations; Aune did not apply multiplicity correction.

Despite the large number of cohorts, for vegans and colorectal cancer, there were much fewer cohorts to draw data from (as shown in the table below).

The two studies overlap considerably in their vegan data, both include AHS-2 and EPIC-Oxford/OVS, yet reach different conclusions. The key differences are that Dunneram et al. includes additional cohorts contributing vegan cases, uses individual participant data allowing more precise adjustment, applies FDR correction, and analyzes rectal cancer separately. Aune’s two contributing studies point in opposite directions (AHS-2: RR 0.88; EPIC-Oxford: RR 1.29), producing a null result.

The vegan colorectal cancer question remains unresolved. Case numbers are small across all studies; Dunneram’s finding rests on roughly 93 vegan cases.

Both papers acknowledge that diet adherence duration, calcium intake, and long-chain omega-3 intake may be important factors not fully captured by diet group classification alone.

I’m in the process of reviewing the literature on omega-3s and colorectal cancer. As for calcium, in her post about calcium and the colon, Ginny Messina makes an interesting point that it might be important to eat a significant amount of calcium that is not absorbed, so that it can bind to bile acids and fatty acids in the colon and prevent them from damaging the colon lining. She’s inspired me to make sure I don’t forget to include some calcium-fortified orange juice and/or soymilk each day.

I’ve updated Cancer and Vegan Diets with this new information.

References

Aune D, Schlesinger S, Sobiecki JG. Vegetarian and vegan diets and cancer incidence: a systematic review and meta-analysis of prospective studies. Eur J Epidemiol. 2026.

Dunneram Y, Lee JY, Watling CZ, Lawson I, Parsaeian M, Fraser GE, Butler FM, Prabhakaran D, Shridhar K, Kondal D, Mohan V, Ali MK, Narayan KMV, Tandon N, Tong TYN, Travis RC, Chiu THT, Lin MN, Lin CL, Yang HC, Liang YJ, Greenwood DC, Reeves GK, Papier K, Floud S, Sinha R, Liao LM, Loftfield E, Cade JE, Key TJ, Perez-Cornago A. Vegetarian diets and cancer risk: pooled analysis of 1.8 million women and men in nine prospective studies on three continents. Br J Cancer. 2026 Feb 27.

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There has been no prospective data on cognition in a cohort that includes a sizable number of vegans. Until now. Maybe.

The Chinese Longitudinal Healthy Longevity Survey (CLHLS) tests cognition every 2–3 years. They deliberately recruit very old adults. Field teams identify centenarians first, then enroll nearby 90–99 year-olds and 80–89 year-olds; they also include 65–79 year-olds (Zeng, 2017).

In January, researchers released a report analyzing prospective cognitive impairment across diet groups among people aged 65 and older, using data from 6 waves of the CLHLS cohort from 2002 to 2018 (Song, 2026).

They defined the diet groups as:

• vegan – abstaining from all animal products
• lacto-ovo vegetarian – consuming dairy and/or eggs but no meat or fish
• pescatarian – consuming fish but no meat
• omnivore – consuming meat at any frequency

Over the course of about 16 years, the vegan group had a trend toward higher rates of cognitive impairment than omnivores (as shown in Figure 3 of their paper). Unfortunately, they didn’t report exact numbers, follow-up duration, or number of measurements. Their Figure 3 indicates that the vegan group had a higher probability of cognitive impairment than omnivores by roughly 1–2% from about age 80 to 100; statistical significance wasn’t reported.

There’s a strong caveat to extrapolating this finding to vegans in general. It seems likely that most of these “vegans” weren’t necessarily choosing to be vegan. Although Song et al. defined vegan as “abstaining from animal products,” there’s nothing to suggest that the diet assessment tool did anything more than measure what people ate, as distinct from what foods they proactively abstain from or what they identify as. That 491 of the 3,554 “vegans” in the study were over 100 years old at baseline adds to my skepticism; it seems very unlikely that the researchers would have encountered so many vegan centenarians, or, if they did, that they wouldn’t have mentioned finding clusters of vegan centenarians. For cohorts that actively recruit large numbers of vegetarians and vegans, such as the Adventist Health Study-2 and EPIC-Oxford, it’s much safer to assume that participants are truly “abstaining” from animal products.

This study also included a cross-sectional arm using baseline characteristics. The vegan group had an odds ratio of being cognitively impaired of 1.32 (95% CI 1.22-1.45, p < 0.001). This was after adjusting for age, gender, social and lifestyle factors (including residence in a city, town, or rural area, and education level), and comorbidities. Adjusting for residence decreased the association for vegans, but didn’t ameliorate it.

Here’s the prevalence of cognitive impairment among diet groups in the CLHLS using cross-sectional data that isn’t age-adjusted:

• vegans: 37.9%
• lacto‐ovo-vegetarians: 42.4%
• pescatarians: 33.7%
• omnivores: 34.4%

While the differences in cognitive impairment between the vegan and omnivore groups was statistically significant, they weren’t massive.

Many in the vegan group were from rural areas (67%) and had little or no formal schooling (70%). I couldn’t find evidence of a nationwide program in China that screens rural older people for vitamin B12 deficiency or provides B12 supplements. If older people avoid or can’t access animal-source foods, and also lack B12-rich fortified foods or supplements, their cognition could likely worsen over time.

They also cross-sectionally analyzed two other cohorts: the Survey of Health, Ageing and Retirement in Europe (SHARE) and the United States National Health and Nutrition Examination Survey (NHANES). SHARE didn’t distinguish vegans from other vegetarians. NHANES had 32 vegans who, at baseline, had a non-statistically significant increased odds ratio of cognitive impairment in the fully adjusted model (OR 1.67, 95% CI: 0.55-5.10).

While this data is concerning, it’s also not surprising: when animal products are absent from the diet long term, and B12 isn’t obtained from fortified foods or supplements, B12 deficiency is highly likely and can impair cognition. To understand the impact of a vegan diet on cognition, people who identify as vegans should be purposefully recruited, their vitamin B12 and other nutrient intakes measured, and their cognition assessed over time.

References

Song Z, He Z, Wang X, Lei C, Ding M, Sun Z, Cao J, Ren G, Di Y. A gradient risk of cognitive impairment with vegetarian diets in older adults: highest for vegan and potential benefit for pescatarian. Food Res Int. 2026 Apr 1;229:118455.

Zeng Y, Feng Q, Gu D, Vaupel JW. Demographics, phenotypic health characteristics and genetic analysis of centenarians in China. Mech Ageing Dev. 2017 Jul;165(Pt B):86-97.

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Dunneram et al. (2026) conducted a meta-analysis of cancer incidence among nine cohorts that included a large number of vegetarians. It found a higher rate of colorectal cancer among vegans.

I’ve added details about the study to the section, Specific cancer incidence among vegans of Cancer and Vegan Diets. I’ve excerpted the Summary here:

A meta-analysis by Dunneram et al. (2026) found higher risks of colorectal cancer in vegans, driven in part by rectal cancer. After removing the first four years of follow-up, the colorectal finding attenuated and was no longer statistically significant, consistent with potential reverse causation or inclusion of early cases. However, a higher rate of rectal cancer for vegans remained statistically significant even after removing the first four years of follow-up and among never smokers.

The overall lower rates of cancer seen among vegans in the AHS-2 and British vegetarian cohorts, should still give vegans an overall benefit in terms of cancer. However, it’s worth monitoring these findings. Vegan case numbers were small (e.g., rectal n≈35 across cohorts), so estimates are imprecise.

In AHS-2 and the British vegetarian cohort, vegans had lower overall cancer incidence; these cohorts suggest vegans tend to have lower overall cancer risk, even though site-specific trends vary.

In the British cohort, colorectal cancer in vegans wasn’t significantly different from regular meat-eaters but trended higher (RR 1.31, 95% CI 0.82–2.11). In AHS‑2, vegans trended lower for colorectal (HR 0.88, 95% CI 0.64–1.22) and higher for rectal (HR 1.13, 95% CI 0.60–2.13), both nonsignificant.

In Dunneram et al.’s meta-analysis, lacto‑ovo‑vegetarians had similar colorectal cancer rates as regular meat‑eaters; pescatarians had lower colon cancer, including after excluding the first four years and among never-smokers. This pattern could reflect nutrient differences; Dunneram et al. noted that vegans had the lowest average calcium and lower long‑chain omega‑3 intakes across cohorts.

We don’t want to be alarmist—the statistics here aren’t strong, and observational data can’t prove causation. We already urge vegans to meet calcium needs with fortified foods (and supplements if needed). I’m more hesitant to recommend universal EPA/DHA supplementation, but the rectal-cancer signal has me re‑evaluating. I’ll be reviewing the EPA/DHA evidence in more depth.

Stay tuned!

Reference

Dunneram Y, Lee JY, Watling CZ, Lawson I, Parsaeian M, Fraser GE, Butler FM, Prabhakaran D, Shridhar K, Kondal D, Mohan V, Ali MK, Narayan KMV, Tandon N, Tong TYN, Travis RC, Chiu THT, Lin MN, Lin CL, Yang HC, Liang YJ, Greenwood DC, Reeves GK, Papier K, Floud S, Sinha R, Liao LM, Loftfield E, Cade JE, Key TJ, Perez-Cornago A. Vegetarian diets and cancer risk: pooled analysis of 1.8 million women and men in nine prospective studies on three continents. Br J Cancer. 2026 Feb 27.

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In June, the Adventist Health Study‑2 released 7.9‑year follow‑up results on cancer incidence by diet group. I revised the VeganHealth page on vegan diets and cancer with a stronger focus on vegans and added a section on whole‑food plant‑based diets to slow cancer progression.

Here’s a quick summary:

Vegans appear to have ~20% lower cancer incidence than regular meat-eaters (i.e., not including pescatarians and flexitarians). No sufficiently large or long studies have assessed cancer mortality among vegans. Lower average body mass index (BMI) explains part of the reduction; other dietary factors likely contribute. Whole‑food plant‑based diets show some promise for slowing progression, but evidence is limited; the plant‑based component may matter more than the whole‑food component.

Read the full article: Vegan Diets and Cancer.

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Until now, I’ve suggested that vegans supplement with zinc if they have signs of deficiency, especially frequent colds or cracks in the corners of the mouth. Recent research suggests that, in general, vegans might improve their health by supplementing with zinc.

A study by Vallboehmer et al. (Germany, 2025) found a high percentage of vegans to be zinc deficient, with evidence that it’s impacting their immune system. Klein et al. (Germany, 2023) also found that a high percentage of vegans are likely zinc-deficient.

For those who opt to supplement, I recommend about 50-100% of the RDA. For vegan adults, the recommended intake is approximately 5 to 10 mg per day. I supplement with 15 mg per day—5 mg in a multivitamin, and a 10 mg zinc-only supplement. I usually take them at different times, just in case it helps with absorption.

I’ve updated the section, Zinc Absorption and Status of Vegans, on VeganHealth.org with the details of this research.

Klein L, Dawczynski C, Schwarz M, Maares M, Kipp K, Haase H, Kipp AP. Selenium, Zinc, and Copper Status of Vegetarians and Vegans in Comparison to Omnivores in the Nutritional Evaluation (NuEva) Study. Nutrients. 2023 Aug 11;15(16):3538.

Vallboehmer F, Schoofs H, Rink L, Jakobs J. Zinc supplementation among zinc-deficient vegetarians and vegans restores antiviral interferon-α response by upregulating interferon regulatory factor 3. Clin Nutr. 2025 Jun 21;51:161-173.

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I’ve added a short appendix, Wound Healing in Vegans, to our Protein page.

Posso et al. (United States, 2025) conducted a review of studies examining the impact of wound healing in vegans and vegetarians. They found poorer wound healing in vegans.

In my opinion, the difference is likely due to lower protein intakes, and possibly zinc intakes, among vegans recovering from surgery.

Vegans with wounds should pay particular attention to obtaining ample amounts of protein and may want to consider taking a zinc supplement of approximately the RDA (11 mg for men, 8 mg for women), in addition to obtaining the typical nutrients of concern in vegan diets (see Nutrition Tips for Vegans).

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Here’s a synopsis of some update I made to the article, Weightlifting for Vegans.

I added some studies on protein. Here’s a summary:

Six studies have compared strength or muscle synthesis or growth between omnivores and 1) vegans, 2) vegetarians with a large number of vegans, or 3) omnivores placed on a vegan diet. The protein intakes of the vegan diets have ranged from 1.1 to 2.4 g/kg of body weight per day. None of the studies found any significant differences between the groups. There seems to be little reason to believe that vegans following strength training programs are at a disadvantage compared to meat-eaters, other things being equal. It’s unclear what level of protein is ideal for vegan weightlifters; it depends on their training program and goals. Experimenting with different protein intakes is the best way for an individual to know what works best for them.

The creatine section was updated with a meta-analysis by Kaviani et al. (2020), which found:

• Vegetarians have lower concentrations of creatine in serum, plasma, red blood cells, and muscle, but not in the brain, than omnivores.
• Creatine supplementation in vegetarians is effective for increasing muscle creatine levels to an extent that vegetarians may achieve higher levels than omnivores. In other words, lower baseline levels in vegetarians seem to allow for “super compensation” of creatine or phosphocreatine levels from supplementation.
• Despite the increased response in creative levels, only one study has shown creatine supplementation to result in greater muscle and performance gains than omnivores, Burke (2003), described here. However, it was also the only study where creatine supplementation lasted longer than a few days or where a resistance training program was part of the protocol.

Finally, some athletes report that their recovery time is quicker after they adopt a vegan diet. One study measured post-training soreness:

Njeim et al. (Canada, 2024) tested soreness between omnivore and vegan women, who were 26.8 ± 4.1 years old, non-exercisers, and apparently healthy. Forty-eight hours after a bout of resistance, eccentric exercises, three of six muscles exhibited less soreness among the vegans compared to the omnivores.

References can be found in the article’s bibliography.

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