Is a vegan diet safe for older people?

The objection

“Old people are losing muscle as it is. Putting a pensioner on a vegan diet is asking for frailty and falls.”

The answer

A vegan diet can work in later life if it is planned around protein, and the objection sits closer to the evidence than many vegans would like. Ageing muscle responds less readily to protein, appetite tends to shrink, and plant foods generally carry less protein per portion, and protein of lower quality, which led Dutch researchers in 2022 to argue that a vegan diet “may not be preferred” at an older age [1]. Trials since then have drawn the line more precisely. Older adults who dropped animal foods and chose their own vegan meals ate less protein, built muscle protein more slowly and lost muscle over 12 weeks (2026) [2], while a planned vegan diet with as much protein as an omnivorous one made no detectable difference to the rate at which muscle protein was built over ten days (2025) [3]. With counselling, a protein target and resistance training, older adults on a vegetarian diet that still included eggs and dairy gained muscle over 12 weeks, though that trial could not show they gained as much as omnivores (2026) [25]. The British Dietetic Association (BDA) says carefully planned plant-based diets can support healthy living “at every age and life stage” [4], and in later life that planning starts with protein.

How much protein do older people need?

Older people need more protein than younger adults, according to geriatric and clinical nutrition experts: at least 1.0 to 1.2 g per kg of body weight a day after 65, which is 70 to 84 g for someone weighing 70 kg, and 1.2 to 1.5 g during acute or chronic illness (PROT-AGE, 2013; ESPEN, 2014) [5][6]. PROT-AGE also advises at least 1.2 g for older people who exercise or are otherwise active [5]. Pointing to Dutch advice that adult vegans eat 1.3 times as much protein because plant protein is less digestible, the researchers behind the 2022 perspective put the figure for older vegans at 1.3 to 1.5 g per kg [1]. The European and UK reference values make no such allowance for age, though the nutrition societies of Germany, Austria and Switzerland set a higher value of 1.0 g per kg for over-65s in 2017, against 0.8 g for younger adults [23]. The European Food Safety Authority’s 0.83 g per kg applies to “adults (including older adults)” (2012) [7], and the UK reference nutrient intake, set in 1991, is 0.75 g per kg, though the British Nutrition Foundation notes that older adults may need more [8]. A 2020 University of Reading review proposed 1.2 g per kg as a UK recommendation for over-65s [9].

Who, and when	Protein advice for older adults
PROT-AGE study group, 2013 [5]	At least 1.0 to 1.2 g per kg a day over 65; at least 1.2 g if active; 1.2 to 1.5 g with acute or chronic illness
ESPEN expert group, 2014 [6]	At least 1.0 to 1.2 g per kg a day if healthy; 1.2 to 1.5 g if illness brings malnutrition or its risk
Domić et al., perspective, 2022 [1]	1.3 to 1.5 g per kg a day for older vegans, allowing for less digestible plant protein
University of Reading review, 2020 [9]	1.2 g per kg a day for UK over-65s
German, Austrian and Swiss nutrition societies (D-A-CH), 2017 [23]	1.0 g per kg a day over 65; 0.8 g for younger adults
EFSA, 2012 [7]	0.83 g per kg a day for all adults, older adults included
UK reference nutrient intake, 1991 [8]	0.75 g per kg a day for adults

Reaching those amounts on plants takes deliberate choices. A Dutch simulation that took the recorded diets of 607 people aged 65 to 79 and simply swapped their animal foods for plant ones, gram for gram, left 56.7% of men and 60.2% of women below an estimated protein requirement adjusted for protein quality, against 7.5% and 11.1% on their usual diets (Borkent et al., 2024, corrected 2025) [10], which shows what an unplanned switch can do. The paper first put the vegan figure at 83%, and a 2025 correction lowered it.

Does going vegan cost older people muscle?

A self-chosen vegan diet cost healthy older people muscle in a 2026 randomised trial, in which their protein intake fell as well. Seventy-two healthy adults aged 65 or over in the Netherlands either kept their usual diet, switched to a vegan diet of their own choosing, or did the same with resistance exercise added [2]. The self-chosen vegan diets supplied 19.3 to 27.7 g less protein a day than before, and after 12 weeks that group had lost 0.61 litres of thigh muscle and 1.15 kg of lean mass from the arms and legs, while the omnivores’ thigh muscle was essentially unchanged (0.01 litres) [2]. In the vegan group that also did resistance exercise the loss was 0.35 litres, smaller but still a loss [2]. Over the first ten days, muscle protein synthesis was also lower on the self-chosen vegan diet, at 1.09% a day against 1.27% on the omnivorous diet and 1.24% in the vegan group that exercised [2]. Its volunteers were healthy people new to veganism, followed for 12 weeks, so long-term vegans were not tested.

Earlier work from the same Dutch research groups shows where the line falls. After a single meal, muscle protein synthesis in 16 older adults ran about 47% higher with a beef meal than with a vegan meal of equal protein and calories (2024) [11]. Over ten days on a varied vegan diet matched to an omnivorous one for protein, though, daily muscle protein synthesis in 34 active adults averaging 72 years old did not differ significantly, at 1.23% against 1.29% a day (2025) [3]. That trial was short, its volunteers averaged 12,460 steps a day, and it measured synthesis rather than muscle mass, so it shows what a planned diet can achieve in fit people and no more.

Another 2026 randomised trial tested a counselled, plant-rich diet over 12 weeks, although its plant group still ate eggs and dairy. Its 108 adults aged 55 and over, with a median age of 66, received dietary counselling for either a lacto-ovo vegetarian or an omnivorous diet, chose their own food with a target of at least 1.2 g of protein per kg a day, and did resistance training three times a week. The vegetarian group reached 1.24 g per kg, 76% of it from plants, against 1.58 g on the omnivorous diet. Both groups gained muscle in the arms and legs, 0.38 kg against 0.66 kg, and both got better at leg presses and a chair stand test with no significant difference between the groups, but the trial could not show that the vegetarian diet built muscle as well as the omnivorous one (van Oppenraaij et al., 2026) [25].

The wider trial record is reassuring on soy and mixed on the rest. Across 30 randomised trials of plant and animal protein for muscle, plant protein produced slightly less muscle mass than animal protein overall, but soy showed no significant difference from milk protein, and in the nine trials of people aged 60 or over the difference was small and not statistically significant (Reid-McCann et al., 2025) [12]. Strength and physical performance did not differ significantly overall, but two results run the other way: in seven whole-diet trials, plant-based diets produced less muscle mass than omnivorous diets with the same protein, and in older adults animal protein did better for leg strength [12]. The authors concluded that there is little evidence so far that protein source matters for older adults’ muscle, while stressing how few trials have been done in people over 60 and how few included frail people [12].

Exercise is the other half of the answer. In that review all 16 trials that included resistance training reported a significant improvement in muscle outcomes, against 21% of the trials without it [12], and ESPEN’s experts, who note that regular aerobic and resistance exercise counteract most aspects of age-related muscle loss, recommend daily activity or exercise for all older people for as long as possible [6]. The NHS advises adults aged 65 and over to do activities that improve strength, balance and flexibility on at least two days a week, and to speak to a GP first if they have not exercised for some time or have medical conditions or concerns [13].

Are older vegetarians and vegans more likely to become frail?

Older vegetarians and vegans became frail slightly more often than meat-eaters in a large Chinese study (2025), while a US study (2022) and a 2025 meta-analysis linked healthy plant-rich diets to less frailty; all three are observational, so none can show that diet caused the difference. The Chinese study followed 27,917 adults aged 65 and over, with an average age of 86.9, for a median of three years: the 1,084 who rarely or never ate meat, fish, eggs or milk had a 12% higher rate of becoming frail than omnivores (hazard ratio 1.12, 95% confidence interval 1.01 to 1.25), with crude rates of 85.6 against 75.0 new cases per 1,000 person-years (Huang et al., 2025) [14]. The vegetarians in it were older, poorer, more likely to live alone and less likely to exercise; the authors noted that people with chewing or swallowing problems may give up meat as they become frail, called the effect small and urged caution [14]. The higher rate was not confined to people avoiding meat at the time: those who switched from a vegetarian diet to eating meat also became frail more often than people who kept eating meat (hazard ratio 1.14, 95% confidence interval 1.02 to 1.27), as did those who stayed vegetarian (1.19) [14]. Among 82,234 women aged 60 and over in the US Nurses’ Health Study, followed from 1990 to 2014, the fifth whose diets scored highest on an index of healthy plant foods, such as whole grains, fruit, vegetables, nuts and legumes, had a 23% lower rate of frailty than the fifth who scored lowest, while an unhealthy plant-based pattern, heavy in refined grains, potatoes, sweets and sugary drinks, went with a 24% higher rate (Sotos-Prieto et al., 2022) [15]. A 2025 meta-analysis of cohort studies in middle-aged and older people, 25 in all across heart disease, frailty and cognitive decline, found the same split for frailty, with higher scores on the healthy plant-based index linked to a 28% lower risk (risk ratio 0.72, 95% confidence interval 0.60 to 0.86) and higher scores on the unhealthy one to a 52% higher risk (1.52, 1.10 to 2.08) (Zhang et al., 2025) [26]. These indexes score how much of a diet comes from healthier or less healthy plant foods and do not pick out vegans, and none of the three studies tested older vegans who planned their protein.

What should an older vegan eat, and which supplements matter?

An older vegan should build the diet around protein-rich foods, take vitamin D and B12, and get calcium and iodine from fortified plant milks, with calcium-set tofu for extra calcium. The BDA’s list of protein foods runs from lentils, beans and chickpeas to seeds, nuts, nut butters, tofu and tempeh, and it counts seitan and soya meat substitutes as high-quality protein, though often high in salt and fat [4]. In the 17 trials that compared them, soy protein showed no significant difference from milk protein for muscle mass (2025) [12]. For a small appetite, the BDA’s advice to older adults at risk of malnutrition is to eat little and often and to add nutrient-dense extras to food, among them ground nuts, nut butter, and pea or soy protein powder stirred into soups, stews and curries [16].

Hip fractures are the other risk, and a serious one: a 2026 meta-analysis calls them an important cause of hospital admission, with high rates of illness and death. Pooling four cohort studies of 529,672 adults, it found that after allowing for other factors vegans had a 75% higher risk of hip fracture than meat-eaters (hazard ratio 1.75, 95% confidence interval 1.17 to 2.63, from 5,344 vegans) and vegetarians a 25% higher risk (1.25, 1.11 to 1.39), and it rated the certainty of the evidence low for vegetarians and very low for vegans (Ballarin et al., 2026) [24]. One of the four was EPIC-Oxford, which followed UK adults for an average of 17.6 years and linked the vegans’ extra fractures partly to lower body weight, calcium and protein. After allowing for body mass index their rate was 2.31 times the meat-eaters’, or 14.9 more hip fractures per 1,000 people over ten years, a finding based on 41 hip fractures among vegans (Tong et al., 2020) [17]. Allowing for calcium and protein intake as well narrowed the ratio only to 1.94 [17], so the recorded intakes of those two nutrients did not account for the whole difference. The sensible course is to cover every known shortfall: calcium-set tofu and calcium-fortified plant milks [18], vitamin D all year for anyone who rarely gets outdoors [19], and reliable B12 [4], alongside the protein and resistance exercise above. Adults need about 700 mg of calcium a day, according to the BDA’s 2021 fact sheet [4], and the 2020 Reading review proposed 1,000 mg for over-65s [9]. The page on vegan bone health has more.

The NHS advises a daily 10 microgram vitamin D supplement all year for anyone who is not often outdoors, such as people who are frail or housebound or live in a care home, and suggests everyone else considers one in autumn and winter [19]. It also warns against taking more than 100 micrograms (4,000 IU) a day, a limit that applies to older people too, adding that some people have medical conditions that mean they may not be able to take that much safely, and that anyone whose doctor has recommended a different amount should follow that advice [19]. Vegans should check the label, because the vitamin D in some products is of animal origin [18].

B12 needs extra care with age. For vegans the only reliable sources are fortified foods and supplements, and the BDA passes on the Vegan Society’s advice to eat fortified foods at least twice a day, aiming for 3 micrograms a day, or to take at least 10 micrograms daily or 2,000 micrograms weekly [4]. Pernicious anaemia, the most common cause of B12 deficiency in the UK, is more common in women around 60, and medicines including metformin and proton pump inhibitors can lower B12; the NHS says GPs know which medicines do this and will monitor you if necessary [20]. A deficiency that is not caused by diet, as in pernicious anaemia, is usually treated with injections of B12 every two to three months for life, so a vegan supplement routine does not replace diagnosis and treatment by a GP [27].

Iodine is another gap. The BDA (2021) says people on fully plant-based diets may be at risk of deficiency and points to iodine-fortified plant milks, advises eating seaweed no more than once a week, and says anyone taking a supplement should speak to a dietitian, because too much iodine is also unhealthy [4].

When should you talk to a GP first?

Speak to your GP, who can refer you to a dietitian [16], before a big change of diet if you take warfarin or medicine for diabetes, have kidney disease or have lost weight without trying. The NHS tells people on warfarin to talk to their doctor before any big change to their diet, because green leafy vegetables are high in vitamin K, which affects how the drug works; you can still eat them, but ask your warfarin clinic for advice [21]. Diabetes medicines lower blood sugar and can push it too low, which the NHS says is common with insulin and can happen with some other diabetes medicines, such as gliclazide and glimepiride, and is more likely if you miss meals or do not eat enough carbohydrate; your diabetes care team can advise [28]. People with severe kidney disease who are not on dialysis may need to limit protein, an exception PROT-AGE makes to its higher targets [5]. Unintentional weight loss, such as losing 5% to 10% of body weight or more over three to six months, is one of the main signs of malnutrition, and people aged 65 and over are particularly at risk; the NHS says to see a GP if you have lost a lot of weight without trying over that time, or are worried that an older person in your care is malnourished [22]. Never stop or change a prescribed medicine because of a change of diet without speaking to your GP first.