Why Vegetarians & Vegans Should Supplement with DHA | Chris Kresser
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Why Vegetarians and Vegans Should Supplement with DHA

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DHA is a crucial nutrient for developing babies, children, and adults, yet there are no sources of DHA in vegetarian or vegan diets. Some advocates of vegetarian diets have claimed that vegans can get enough DHA by consuming plant-based forms of omega-3 like flaxseeds and walnuts. But is that really true? Read on to find out.

vegan dha supplement
Cold water fatty fish is a good source of DHA, a nutrient lacking in the vegetarian or vegan diet. istock.com/richcarey

A couple of weeks ago, Joe Rogan invited me to be a guest on his top-ranked podcast. Joe is a fantastic guy, a skilled interviewer, and knowledgeable about health and nutrition in his own right.

We covered a variety of topics, including Paleo and vegan vs vegetarian diets; Big Pharma, Big Food, and Big Science; functional vs. conventional medicine; and the importance of lifestyle and behavior change.

One of the particular issues we discussed related to vegetarian and vegan diets was the importance of long-chain omega-3 fats like EPA and DHA. I summarized research indicating that vegetarians, and particularly vegans, have lower levels of EPA and DHA than omnivores and that plant-based omega-3 fats like flaxseed and walnuts are not adequate sources of EPA and DHA in most cases. I argued that most vegetarians and vegans will need to supplement with preformed DHA—from microalgae, for example—in order to ensure adequate levels of these important fatty acids. I stand by this claim, and, as you’ll see below, the evidence clearly supports it.

What I got wrong on the show was that vegans need to take several capsules of microalgae supplements in order to meet their daily DHA needs. In fact, with most microalgae products on the market today, vegans can take one or two capsules a day to meet that need. I was basing the larger number of capsules on a higher target of DHA per day that I previously recommended, but I have since revised my view on based on new research suggesting potential harm from too much omega-3 fat. That’s an important difference, and I apologize for any confusion it may have caused.   

One final note before we dive in. As I said numerous times on the show, I am not arguing that it’s not possible to be healthy on a vegan diet. Spectacular athletes like Rich Roll demonstrate that it is. My argument is that 1) there is a higher risk of nutrient deficiencies on a vegan diet (including DHA, the subject of this article), especially without smart supplementation, and 2) there are numerous factors that determine whether one becomes nutrient deficient on a vegan diet, which explains the wide range of responses. If someone is going to commit to a vegan diet, these are the facts they need to be aware of in order to increase their chances of success.

DHA and Vegans in a Nutshell

This is going to be a long article filled with a lot of scientific references because I want to provide a comprehensive summary of what the research says on this topic. But I also want to make it accessible to people who aren’t scientists or healthcare professionals. I’m going to summarize the key takeaways right up front, and then I’ll go into further detail on each of them below.

Here’s the 30-second summary:

  • In all but one study I’ve seen, omnivores have the highest DHA levels, followed by vegetarians, followed by vegans.
  • Conversion of ALA to EPA and DHA is inefficient: less than 5 to 10 percent for EPA and 2 to 5 percent for DHA.
  • Even those low numbers may be optimistic because most studies show that supplementing with plant-based forms of omega-3 (alpha-linolenic acid, or ALA) like flaxseed oil does not increase serum or breast milk levels of DHA.
  • The conversion of ALA to EPA and DHA is inhibited by linoleic acid (plant-based omega-6), nutrient deficiency, genetics, health status, and sex. This may explain why ALA is a sufficient source of DHA for some vegetarians and vegans, but not for others.
  • DHA plays a crucial role in fetal and childhood brain development (affecting visual acuity, intelligence, problem solving, etc.), and a growing body of evidence shows that adults that consume higher amounts of DHA have lower risk of many diseases, including cognitive decline, Alzheimer’s disease, depression, schizophrenia, psychosis, and other behavioral disorders.
  • Therefore most vegetarians and vegans should supplement with preformed DHA to ensure adequate levels of this crucial fatty acid.

Omnivores Have Higher Levels of DHA Than Vegetarians or Vegans

Numerous studies have shown that, on average, omnivores have higher levels of DHA than vegetarians and vegans, with vegans at the bottom of the scale. For example, one study in 196 meat-eating, 231 vegetarian, and 232 vegan men in the United Kingdom found the following EPA and DHA levels, by group (1; see Table 2):

EPA levels (mg/L):
Omnivores: 0.72
Vegetarians: 0.52
Vegans: 0.34

DHA levels (mg/L):
Omnivores: 1.69
Vegetarians: 1.16
Vegans: 0.7

Lest you think this effect is limited to white males in the UK, similar results have been found in studies of Austrian, Dutch, Australian, Finnish, Chinese, and US adults. (2, 3, 4, 5, 6, 7, 8) The authors of the Austrian study noted that vegetarian diets promote “biochemical tissue decline” and that vegetarians and vegans “should supplement with preformed EPA and DHA, regardless of age and gender.” (2)

This leads to three conclusions:

  • There is less EPA and DHA in the typical vegetarian and vegan diet than in an omnivorous diet
  • Vegetarians and vegans are not converting ALA into EPA and DHA at a rate sufficient to match the serum DHA levels of omnivores
  • Vegetarians and vegans are either not supplementing with DHA at all, or they are not taking enough, since their blood levels are lower than those of omnivores

Why Do Vegetarians and Vegans Have Lower Levels of DHA Than Omnivores?

Now that we’ve established that vegans and vegetarians have lower levels, on average, of DHA than omnivores, let’s explore why this is the case. There are two primary reasons:

  1. Lower intake
  2. Reduced conversion

Lower intake

This one is quite simple: EPA and DHA are found almost exclusively in animal foods. Seafood and marine oils are the primary source, but pasture-raised meat and dairy products (and, to a lesser extent, conventionally raised meat and dairy) also contain modest amounts. The only significant source of preformed DHA in plant foods is microalgae (which is why most vegan DHA supplements are made from it). (9)

Reduced conversion

This one requires a bit more explanation, but it’s crucial to understand, so please bear with me.

A fatty acid is a chain of carbon, oxygen, and hydrogen atoms with a carboxyl group on one end. Fatty acids are classified on the basis of how many carbon atoms are in the chain, as well as how many double bonds exist within the molecule.

As you can see from the chart below, it is also possible for the body to synthesize EPA and DHA from the short-chain omega-3 alpha-linolenic acid (ALA). ALA is found in plant foods such as flax, hemp, and pumpkin seeds and walnuts.

diagram-650-1

Adapted from Das UN. Biotechnol J. 2006 Apr;1(4):420-39

 

Looking at this chart, it’s easy to see why a vegetarian or vegan might assume that they can meet their DHA needs simply by consuming flaxseeds and walnuts.

However, research indicates that the conversion of ALA to EPA and DHA is inefficient and extremely limited. Less than 5 to 10 percent of ALA gets converted to EPA, and less than 2 to 5 percent gets converted to DHA. (9)

Even these low conversion rates may be a best-case scenario, especially in the case of DHA. Why? Because ALA supplements have little effect on blood or breast milk DHA levels in adults, and although adding ALA to infant formula does raise DHA in babies, it doesn’t raise it to the level that babies get from consuming breast milk. (10)

This is hugely important because, as we’ll see below, DHA is an essential nutrient for fetal brain development, and low maternal DHA levels are associated with lower IQ and visual acuity and suboptimal brain development.

Another important point to understand is that a wide variety of factors—some of which are common in people following a vegetarian and vegan diet—may further inhibit the conversion of ALA to DHA. Studies have shown that the conversion of ALA to EPA and DHA is inhibited by linoleic acid, nutrient deficiency, genetics, health status, and sex. (11, 12) Let’s look at each of these in turn.

Linoleic acid

Linoleic acid (LA) is a plant-based omega-6 fat, found in things like nuts and seeds, avocados, and industrial seed oils used in virtually all packaged, processed, and restaurant foods. Studies have shown that vegetarians and vegans have a high intake of LA compared to ALA—an average ratio of 10:1—which would impair conversion of ALA to DHA. (2) In addition, a large proportion of dietary ALA is oxidized, and thus unavailable for conversion into DHA. (13)

Recent research suggests that the optimal conversion of ALA to DHA occurs at a ratio of LA to ALA of 1:1. (14) However, reducing LA intake that significantly is extremely difficult to achieve when following a vegetarian or vegan diet. Other studies have shown that a ratio of between 2 and 4:1 may still allow for adequate conversion, but note that this is still significantly lower than the average omega-6 to omega-3 ratio of 10:1 for vegetarians and vegans. (2, 15)

Nutrient deficiency

If you look back at the chart above, which demonstrates the conversion pathways of essential fatty acids, you’ll see that there are several important enzymes in that pathway: delta-5-desaturase, elongase, and delta-6-desaturase. Like all enzymes, these require certain nutrients as cofactors in order to function properly. These include vitamins B3 and B6, vitamin C, magnesium, calcium, selenium, iron, and zinc. (16, 17, 18, 19)

As I’ve written elsewhere, vegetarians and particularly vegans are at higher risk of deficiency of some of these nutrients—especially iron. Vegetarians and vegans have lower iron stores than omnivores, and vegetarian diets have been shown to reduce nonheme iron absorption by 70 percent and total iron absorption by 85 percent. (20, 21)

This suggests that deficiencies in vegetarians/vegans of nutrients that are required for optimal conversion of ALA to DHA may further explain why their levels of DHA are lower than omnivores.

Genetics

Delta-5- and delta-6-desaturases are encoded respectively by the FADS1 and FADS2 genes. Recent research has shown that different FADS1 and FADS2 genotypes are associated with significant differences in DHA levels. (24) This shouldn’t be surprising, since, as you now know, the delta-5- and delta-6-desaturases play an important role in the conversion of ALA to DHA. A variety of other genes have been shown to affect this conversion as well. (18)

Quite simply, this means that there are genetically determined individual differences that affect the rate of conversion of ALA to DHA. This could explain why some vegans are able to maintain higher levels of DHA without supplementation than are others.

Health status

Studies have shown that the delta-5 and delta-6 conversion enzymes don’t function as well in people with diabetes, metabolic syndrome, hypertension, or certain metabolic disorders. (16, 18) Like genetics, differences in health status can influence individual conversion of ALA to DHA and may explain some of the variation observed in vegetarians and vegans.

Sex

Finally, it appears that young women convert significantly more ALA to DHA than young men. The most likely explanation is that this is nature’s way of ensuring adequate levels of DHA in pregnant and lactating women, which, as you will see below, is crucial to the health of the developing baby and child.

One study showed that women converted 21 percent of ALA to EPA and 9 percent to DHA, whereas men converted 8 percent of ALA to EPA and 0 percent for DHA. (25) Yes, you read that correctly: zero percent conversion in men. This led to an average conversion of ALA to DHA in men and women combined of 4.5 percent, but obviously that average doesn’t tell the whole story. This may explain why, anecdotally at least, men don’t do as well on vegan diets as women.

Why Is DHA so Important—and How Much Do We Need?

The importance of DHA in the diet has been widely covered in both the mainstream media and the scientific literature for the last two decades. DHA is an essential nutrient for fetal brain development, and low maternal DHA levels are associated with lower IQ and visual acuity and suboptimal brain development. (26, 27, 28, 29, 30, 31)

Some studies argue that the lower DHA levels observed in vegetarians and vegans do not constitute overt deficiency and that evidence of harm is limited. Vegans have used this as an argument that DHA supplementation isn’t required.

However, a growing body of evidence suggests that even adult requirements for DHA may be higher than currently recognized and that adults who consume higher amounts of DHA have lower risk of cognitive decline, Alzheimer’s disease, cardiovascular disease, depression, schizophrenia, psychosis, and other behavioral disorders. (32, 33)

This shouldn’t be surprising, given that the RDA for each nutrient is the amount required to avoid deficiency symptoms—not the amount required to promote optimal health, which is often much higher than the RDA. There are numerous examples of where the RDA is likely insufficient for promoting optimal health—such as zinc, iron, and B12—and given the research above, DHA seems to be another.

But how much DHA do we need? Recommendations vary widely depending on the country and organization, ranging from 100 mg/d on the low end to 300 mg/d on the high end. Based on research linking DHA with all of the benefits mentioned above, a panel of experts at the National Institutes of Health (NIH) recommended a daily intake of EPA and DHA combined of 650 mg/d, with at least one-third of that amount (approx 215 mg/d) coming from DHA. (34)

In theory, with a conversion rate of 2 to 5 percent of ALA to DHA, this means vegans and vegetarians would need to consume between 4.3 and 10.8 grams of ALA per day to produce 215 mg/d of DHA, depending on where they fall in the conversion spectrum.

How does that compare to the average intake of ALA in the United States? According to a study of more than 14,000 men and women in the US, the intake of ALA is 0.97 g/d in vegetarians and 0.86 g/d in vegans. (35) This is obviously well below the range needed to produce 215 mg/d of DHA.

Some vegans have argued that even the higher dose of 10.8 grams of ALA per day is easily obtainable simply by taking a tablespoon of flaxseed oil. However, as I mentioned earlier in the article, most studies show that supplementing with ALA does not increase DHA levels in the serum or breast milk, so it seems that in many cases flaxseed oil will not solve the problem. (10, 36)

Given the high intake of LA and low or nonexistent intake of EPA and DHA in vegetarians and vegans, it wouldn’t be surprising to see low tissue levels of EPA and DHA in these populations. That’s exactly what research shows. For example, one study found that EPA levels of vegans were only 12 to 15 percent and DHA levels were 32 to 35 percent of those of omnivores. (37) Another study found that EPA levels in vegans were only 22 percent of those of omnivores, and DHA levels were 38 percent of those of omnivores. (38) Finally, and most concerning, a study found that vegan infants had less than 30 percent of the EPA and DHA of omnivorous infants. (39)

Conclusions

I started with the conclusions of the article in the introduction, but let me review them again here:

  • Vegetarians and vegans have lower levels of EPA and DHA than omnivores. This indicates that they aren’t getting enough ALA in their diet to produce sufficient DHA and that most vegetarians and vegans aren’t supplementing with preformed DHA.
  • The conversion of plant-based forms of omega-3 found in foods like flax seeds and walnuts into EPA and DHA is inefficient.
  • Supplementing with ALA  (e.g., flaxseed oil) does not adequately increase serum or breast milk levels of DHA.
  • DHA is crucial to human health during gestation, childhood, and adulthood.
  • Therefore, most vegetarians and vegans should supplement with preformed DHA to maintain optimal blood levels.

This is especially true for populations with higher DHA requirements, like pregnant and lactating mothers, and in those with poor conversion, like men, people with nutrient deficiencies, and people with chronic illness. As discussed in the article, ALA supplements like flaxseed oil aren’t sufficient in most cases, and supplementation with preformed DHA is necessary for maintaining optimal blood DHA levels.

The best option for those unwilling to consume seafood is a microalgae supplement. Algae is the base of the food chain for fish, and it is rich in DHA. (DHA can be retro-converted to EPA, so it is not necessary to supplement with EPA separately.) Most products on the market contain about 200 mg of DHA per capsule, so a dose of one to two capsules per day would suffice.

For those who are not vegetarian or vegan, however, the best option is to simply eat 12 to 16 ounces of cold-water fatty fish per week. This not only provides adequate amounts of preformed EPA and DHA, but it also provides highly bioavailable protein and other nutrients like selenium that are important to health. Although I’ve written extensively about why concerns about mercury in most fish species are overblown (here, here, and here) and why the benefits of eating fish far outweigh the risks, if you’re concerned, you can simply choose low-mercury species (which is what virtually all public health organizations recommend). And contrary to what some have claimed, dioxins and PCBs are not a significant health concern when it comes to seafood consumption.

I’ll close by recognizing that there are many reasons why people choose to go vegetarian or vegan. Some are compelled by the environmental impact of confinement animal feeding operations (CAFO). Others are guided by ethical concerns or religious reasons. I respect these reasons and appreciate anyone who thinks deeply about the social and spiritual impact of their food choices—even if my own exploration of these questions has led me to a different answer.

If you do choose a vegetarian or vegan diet for yourself and/or your children, understanding how to mitigate any possible adverse effects of that choice—in this case, suboptimal intake of DHA—will maximize your chances of success and minimize your chances of harm. I hope that this article serves that purpose.

220 Comments

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  1. I was vegetarian for a while in the late 1960’s and then I floated out of my body. It is very nice to know that I am not this body, but it scared the be-jesus out of me. My spiritual mentor said that I should eat some meat as meat is heavy enough to keep me anchored to my body. That worked.

  2. I’m not a vegan…but will pass your article on to one, who makes a lot of “food choices” that do not contribute to his health!

  3. I am shocked at this jumbled collection. Not up to the usual standard by any means.

    A few courses in statistics, how to interpret studies, etc are needed.

    • I would suggest rather than doing that. Pass on Becoming Vegan writteb by two world renowned vegan dietitians and the cover DHA needs.

      No vegan wants to get advice from someone shaming and disparaging their choice and …beans, cooked tubers and some grains are essential for plant proteins and calories. So they should not get advice from someone wanting to reduce those in diet to reduce your carbs- a recipe for disaster!

  4. To Chris Kresser: Would you please post a recommendation for an algal oil that would be high quality. I see these supplements in stores but never know what is a good one from a not-so-good one. Most fish oil supplements cause boils for me, as well as cod liver oil. I have tried several and have now decided to try algal oil. I would probably be low in DHA but have not been tested for that yet.

    • I don’t know Chris’s recommendation, but check out opti3 – its hexane free and contains a good amount of both dha and epa

  5. Thanks for excellent science synthesis, Chris.

    In an article at veganhealth.org from 2014 there are warnings about negative health issues from too much ALA (pertaining to eye vision in particular). I have a patient, a 60 y o strictly vegetarian man with declining vision, which is why I am interested in this issue.

    What are your thoughts on negative effects of ALA per se?

    Article:
    http://www.veganhealth.org/articles/omega3#SumBenCon

    Excerpt from article:
    “If it weren’t for the (small chance) for potential eye problems, I would suggest either adding 3 g of ALA per day or taking DHA supplements. Because of the eye issues, that much ALA is not worth the risk when DHA supplements are available. I would still recommend adding about .5 g of ALA per day for its own benefits for heart disease and to help increase EPA levels. If using such small amounts of uncooked, plant sources of ALA the risk to the eyes should be minimal.”

    • The problem with consuming a lot of ALA as a means of reaching DHA targets is that most people are already eating large amounts of linoleic acid (LA), another polyunsaturated fat. These fats are highly unsaturated and susceptible to oxidative damage, and most studies have suggested limiting them to 7% of overall calories if possible.

      This is why it’s better to simply consume a smaller amount of pre-formed DHA than eating larger amounts of ALA.

  6. Hi Chris,

    Thank you for the article and consideration. I know you are big into paleo/ ancestral diet. I see nutrient deficiencies with most patients in my practice. When I first started practicing medicine 16 years ago, I didn’t address diet (because it’s a loaded topic- many levels, emotional being a big component). I wasn’t getting the health results I get now by addressing everyones diet. You add in sensitivities to food, toxic load, genetics, etc and it gets interesting. What I”m getting at- education is the best piece of this. There is no ideal diet out there, they all have their pitfalls. I think as medical professionals, it’s best (as you do), to educate folks about their choices. I’d like to see the tone of the discussion turned down. Yes vegetarians and vegans have to be aware of this along with B12 levels and absorption. Though I’d say EPA/DHA is lacking in the majority of peoples diets I see day to day. Thank you for what you do! Keep up the great work.

    • Totally agree, the tone feels very disrespectful to me.

      I would go so far as rewriting an edited, more respectful version.

  7. Two questions:

    1) Why is Alzheimers and dementia lower in vegans and vegetarians if they are sub optimal DHA?

    2) Do meat-eaters need more DHA because the meat is causing the dementia and Alzheimers?

    • 1) You can’t look at observational studies showing an *association* between lower incidence of dementia and Alzheimer’s in vegetarians and vegans and conclude that is a causal relationship. Observational studies don’t prove causality, and they can be very misleading because of something called the “healthy user bias”.

      I explain the healthy user bias in this article: https://chriskresser.com/why-you-should-think-twice-about-vegetarian-and-vegan-diets/

      “…is the scientific way of saying that people who engage in one behavior that is perceived as healthy (whether it is or not) are more likely to engage in other behaviors that are healthy. For example, vegetarians tend to be more health conscious on average than general population; they are less likely to smoke or drink excessively and more likely to exercise, eat fruits and vegetables and take care of themselves.” http://www.ncbi.nlm.nih.gov/pubmed/17411462/

      Fortunately, there have been studies that have attempted to control for this bias. For example, one study compared the mortality of people who shopped in health food stores (both vegetarians and omnivores) to people in the general population. This was a clever study design. People who shop in health food stores are more likely to be health conscious, regardless of whether they eat meat, which reduces the likelihood that the study results will be thrown off by the “healthy user bias”. What did the researchers find? Both vegetarians and omnivores in the health food store group lived longer than people in the general population—not surprising given their higher level of health consciousness—but there was no survival difference between vegetarians or omnivores. Nor was there any difference in rates of heart disease or stroke between the two groups. In other words, omnivores who are health conscious live just as long as vegetarians that are health conscious. http://www.ncbi.nlm.nih.gov/pubmed/8842068

      2) This become a moot point when my answer to #1 above is considered. Since consuming meat has been viewed as “unhealthy” for so many years, omnivores in observational studies showing a correlation between meat consumption and dementia/Alzheimer’s are more likely to smoke, be physically inactive, not eat fruits and vegetables, and engage in other behaviors that have been shown to increase the risk of cognitive decline. Therefore it’s impossible to say that the meat consumption is what’s causing the higher incidence of cognitive disorders.

      Given that animal products are the only source of B12 and DHA (outside of algae in the case of DHA), it’s in fact likely that B12 and/or DHA deficiency could contribute to Alzheimer’s/dementia, and may even be misdiagnosed as those conditions:
      B12
      http://www.ncbi.nlm.nih.gov/pubmed/15681626
      http://www.ncbi.nlm.nih.gov/pubmed/10589285
      http://www.ncbi.nlm.nih.gov/pubmed/11994220
      http://www.ncbi.nlm.nih.gov/pubmed/10713580
      http://www.ncbi.nlm.nih.gov/pubmed/7976784
      DHA
      http://www.ncbi.nlm.nih.gov/pubmed/9060973
      http://www.ncbi.nlm.nih.gov/pubmed/27358067
      http://www.clinicalnutritionjournal.com/article/S0261-5614(07)00189-6/abstract

      • B-12 deficiency could look a lot like Alzheimer’s, but lack of eating animal products is not to blame. The vast majority 95%+ of those with B-12 deficiencies are not from lack of eating animal products. So… will not be solved by trying to get people not to adopt vegetarian and vegan diets. The key is to get all people over 50 to take B-12 supplements and/or eat fortified foods, stop prescribing proton pump inhibitors, but rather change diets, as first line of treatment, and to quickly respond to food intolerances, such as lactose, gluten etc.. before GI disruption and dysbiosis occurs.

        And lowered DHA in AD, which has much higher prevalence in omnivore, does not prove causality. Heavy meat eaters population worldwide is actually much higher prevalence and the lowest known prevalence of AD in Ballabgrth,India was in a vegetarian population.

        AD is a vascular disease and the comorbity of atherosclerotic plaque in the brain, as well as comorbidity of hyperlipidemia in midlife and beyond is well documented. Also, well documented his iron accumulation in amyloid plaques.

  8. Dr. Kresser,

    Please supply a bibliography at the bottom of your informative articles so that one may follow up the references at leisure.

    If you believe that some of your readers would respond negatively to such documentation, please follow the practice of Dr. Mercola (mercola.com) and allow interested readers to display the bibliographic information with a single click.

    • Alexandra,

      As with every article I write, the references are listed at the end of each sentence, in numeral form, and they are hyperlinked. You can click on the number and go right to the study. This method is superior to a bibliography because it is clear what study relates to what claim I am making in the article.

  9. Deeply disappointed. I am 72, veggie/vegan and only rarely on a special occasion eat marine , and don’t ever consume fish oils. My health is very good. The arguments that veggie/vegans have less w-3 components in their bloodstream and tissues is believable. Low conversion from such things as flax seed oil is believable. Both outcomes are measurable and can rely on short term testing. However, the argument that we need supplementation or need to consume more fish in order to reach certain levels is based only short term studies, which are not at all consistent or conclusive, especially with respect to long term usage and health effects. I believe Chris suffers from confirmation bias. He should report on the many studies that conflict with his point of view if he is to be considered a scientist. Frankly, theories as espoused in the article absent conclusive data on long term effects (over many years) are not worth the paper they reside on, and can even be dangerous.. Look up yellow fat disease.

    • What many studies? I’m still waiting for someone to show me these. I have 40 citations in this article. All but one study I’ve seen reported higher levels of DHA in omnivores than vegetarians and vegans. All studies I’ve seen show low conversion of ALA to DHA. Most, if not all, studies I’ve seen show that ALA supplementation doesn’t lead to increases in serum or breast milk DHA that are equivalent to what DHA supplementation does.

      You are free to disagree, but your comments would carry more weight with readers if they were backed up by actual evidence, rather than general statements and ad hominem attacks of “confirmation bias”. When someone accuses another of confirmation bias, but prevents no evidence to support their view, who is guilty of the bias?

    • This is my concern too. The Cornucopia Institute has been trying to get this Martek Biosciences’ DHA off the approved organic list since it isn’t! And many quality supplement companies continue to use it in their products lines. Worse, baby infant formulae (except Baby’s Own) derive their plant based DHA from this algae source.

    • I have never been a supporter of high doses of fish oil for this, and other reasons. See this article: https://chriskresser.com/should-you-really-be-taking-fish-oil/

      Instead I recommend eating about 12-16 ounces (depending on your body weight and total calorie intake, whether you are pregnant/lactating, etc.) of cold-water, fatty fish per week. That is more consistent with our evolutionary intake of these marine fats.

    • There is hexane free algae oils u thought, and this is believed to be in high doses of fish oil correct??

  10. My mother was a vegetarian when I was in the womb and breastfeeding for 2 years, right on the heels of her first pregnancy–no recovery time!. My studies in nutrition and health, it became clear, were about taking deeper charge of my health, to a good extent due to that. I was born with a short second third (nose) which later reversed probably from raw milk in childhood. I have spent a life, first just trying to survive, then succumbing to vegetarianism for enough years to intuitively push me back to selective meat consumption. For my northern Euro background, and hers, not eating meat has tricked downhill to land me with a host of issues that only after serious study on my own, I have mostly in hand.

  11. Chris, does your somewhat negative/cautious view of high dose (6g EPA/DHA per day) fish oil apply to people like me who are trying to control/reduce high Lipoprotein(a)? As far as I know high dose fish oil is one of the few therapies that at least has some data indicating that it can reduce Lpa, unlike statins or other traditional cholesterol lowering therapies that seem to have no impact. If high dose fish oil has more risk than benefit for Lpa, what do you think would be better?

    • That’s a good question. In my practice I’ve seen reductions of >40% of Lp(a) by addressing underlying mechanisms that contribute to dyslipidemia, such as GI pathology (SIBO, leaky gut, etc—even when the patient doesn’t have gut symptoms), thyroid hypofunction, chronic infections (like H. pylori), environmental toxicity (heavy metals), and metabolic dysfunction.

      Beyond that, there are new drug options like PCSK9 inhibitors and anti-sense that have a lot of promise.

      I would be uncomfortable with high-dose EPA & DHA supplementation *especially* for someone with high risk of CVD for the reasons I outlined in this article: https://chriskresser.com/should-you-really-be-taking-fish-oil/

      • Thanks Chris. Appreciate your views. Unfortunately, my history is that I already have CVD. Had an almost complete LAD block, angionplasty with stent placement, about 13 years ago (age 46), despite having fairly normal cholesterol, normal weight etc. About 5-6 years ago, through publications/sites like yours, I decided to go pretty much paleo, cutting way back on the grains/sugar and other inflammatory foods that I had been consuming for so long. Soon after, I accidentally discovered Lpa through a variety of resources like Davis’ Wheat Belly/Dayspring/Masterjohn etc., got tested and voila, finally discovered why a skinny, young guy almost died of CVD – high LDL particle counts exacerbated by inherited, high Lpa, plus systemic inflammation/gut dysbiosis due to an out of balance, relatively high carb diet.

        It was primarily Dr. Davis’ view on Lpa that convinced me that using high dose fish oil to reduce inflammation could be useful. So, I’ve been following this path, realizing that it’s probably not a silver bullet. I know that eating whole foods like sardines, salmon and lots of leafy greens/berries/other nutrient dense veggies is also important, in addition to trying to keep fit.

        Beyond watching my diet and doing CrossFit, I will surely follow drug developments like PCSK9 (IonisPharma Apo(a)?). I will also get my thyroid markers assessed along with my lipid particle counts shortly. We’ll see if the Lpa numbers are down after more than a year on the fish oil. If they aren’t maybe I’ll reassess my strategy and pull way bay on the fish oil. Not sure there is much else that people like me with known CVD can do.

        Thanks again for all your work re: diet, health etc. It played a critical role in helping me to finally get some kind of handle on my predicament.

  12. Unfortunately, you left one important factor out: the vegan DHA is made out of seaweed, and not fish (for obvious reasons). It is well established that the seaweed DHA is not the same form as the one found in fish (similar problem as retinol vs b.carotene, or active vs inactive B12, or heme vs non-heme iron). So getting seaweed DHA won’t actually help all that much. On top of that, vegan DHA supplements almost never have more than 500 mg of DHA, while they have bucketloads of EPA in these same pills. Omnivores have much better DHA pill options, with as high as 1000 mg, and 250 mg of EPA (EPA is not as good as DHA to have too much of). Bottom line, if veg*ns want to be truly healthy, they need fish-derived DHA supplements, not a vegan one. Which is something that won’t sit well with them, making the whole argument moot, since they won’t be convinced.

    • Eugenia, you missed a couple of important factors also:

      1. If you read the links I submitted, you see that vegans on average do a much better job of making their own DHA from the parent omega-3 (ALA) that they consume. So on average, they will need LESS supplementation than average omnivores.
      2. If you read Chris’s chart of the Eicosanoid cascade to see how DHA is derived in the human body you will discover that nobody, vegan or omnivore included, needs to start from the parent ALA to derive DHA. If a person has plenty of EPA, there is only one more step from that to derive DHA (notice Sprecher’s shunt). Thus the supplements that you say vegans often use are actually very close to supplying a lot of DHA, lacking only one more step of conversion. And again, if you read the links that I supplied elsewhere, you’ll see that vegans are very good at doing all the conversions in order to derive DHA. So supplements high in EPA are good things for vegans, right?

      I’ll mention one more thing. These studies worked with average “vegans” and average “omnivores”. No special diets to exclude excess and ruined omega-6 oils that hamper the conversions to DHA that this article is focused on. Get a test group together that actually cleans their diets of high ratios of omega-6 to omega-3 and who knows what nice conversions you might find, even in the vegans. So far, I haven’t seen a study that shows what truly healthy eaters accomplish to convert basic food to DHA, but considering how healthy, whole food is so remarkable generally, I rather think that humans astute enough to read this article are very likely doing just fine without supplements.

      BTW, I’m not a vegan, and I still take some supplements, though I am a bit afraid of supplemental omega-3 as it’s so hard to know the quality (rancidity) of a polyunsaturated oil supplement. One must be advised that DHA is about 3 times as perishable as parent omega-3, so anyone making or taking supplements better make sure they are consuming safe products, or they are worse off than ever.

      • Glenn, that is not entirely true. Young women are efficient converters of DHA (9% in one study), which makes sense given the evolutionary imperative. But men in that same study converted 0%. I think it’s crucial to understand these differences.

        I don’t believe the evidence is strong enough regarding differences is algal sources of DHA and fish sources. Studies have shown that algae supplements do increase serum levels of DHA.

    • Chris you disappoint me here…it’s a good think to be fair, but don’t claim that you may thrive in the long run with vegan diets…if nature, through evolutionary selection, made us carnivores-frugivores, you can be sure that in the long run you have deficiencies. Nature is a complex system of billions of variables working at the same time, and you dude know it perfectly. In light of that, supplements are not real food and you can never reach the amazing complexity of a real animal food through a supplemented vegan diet.
      If being fair means betraying the truth, I don’t want to be fair and you shouldn’t disguise the truth with an “half” lie to make the pill (vegan propaganda) less bitter.
      I appreciate your effort to be unbiased, but the vegan issue requires to be treaten with bias, because in this case we have all the reasons to be biased against it.
      That said, everyone should be free to decide for himself, but don’t sell that stuff to the others please. You have against the evolutionary and antropological evidence, rct, etc… Chris, if you claim to be an evolutionary based clinician, don’t feed the vegan dogma in any way.

    • How can you claim that one may be healthy in the long run in a vegan diet? Aside from DHA, What about B12, zinc, vitamin D, taurine, creatine, carnitine, bioavailable complete proteins?
      Do you think to supplement all of this stuff ignoring the food synergy crucial role? Food is so muuuuch more than A or B…and real animal food is much more than DHA or any other single compound taken alone. Chris, you should know it better than any other since you run an evolutionary based clinic. We evolved through selection to be carnivores-frugivores and humans can never thrive on a vegan diet on the long run.

      • I appreciate that you want to be unbiased and fair, but being fair toward vegan diets through half lies is going to ridiculize your practice.
        Have the guts to take strong positions since in this case we have evolutionary and antropological evidence, studies and direct evidence from vegan populations (indians for ex) about the nutritional disaster of vegan diets. It doesn’t fit with our evolutionary path, that’s all, and have the courage to say it.

        • So what about top vegan athletes who are clearly thriving? Many long term vegans are in excellent health…

          The evolutionary argument is stupid, since you are sitting in a warm, comfy house typing away on a computer. There are many things that are not part of the evolutionary path that we humans are using to enrich our lives…and even those people eating an ‘ancestral diet’ are eating very different foods to our ancestors. So please, allow Chris to do what he does best, which is supporting people’s health regardless of their personal belief systems.

            • I also linked Chris’ article that was very good.
              If I could afford it, I’d like to attend to the clinician course as well.
              Don’t cave in with religions Chris.

          • Yes, sitting and chronically sick.
            The evolutionary mismatch is apparent, otherwise we wouldn’t be here to discuss about health issues and humans would be happy, free and healthy.
            I am indeed stupid because I’m still responding to this post…I’m romantic and believe in changing but vegans never change…

      • RE, the comment: “…evolved through selection to be carnivores-frugivores and humans can never thrive on a vegan diet on the long run.”

        the, mostly vegetarian, population of India has doubled in less than 50 years -from 600 millio to 1.2+ billion.

      • “How can you claim that one may be healthy in the long run in a vegan diet? Aside from DHA, What about B12, zinc, vitamin D, taurine, creatine, carnitine, bioavailable complete proteins?”

        It is astonishing that someone still swallows the myth, created by agro industry, that plant proteins can’t be complete.

        Perhaps you would care to educate yourself. There are
        ample proteins in a plant based diet and complete ones.

        https://ndb.nal.usda.gov/ndb/
        http://michaelbluejay.com/veg/protein.html

            • To be sincere, I don’t like to force people and though I’m strongly against veganism, I agree to a certain point that we are getting less free.
              That said, you make cherry picking with a couple of very weak supporting articles, against the hubris of evidence you have for the other way. If this is not religious bias…

                • Are you aware about antinutrients?
                  This is getting very silly.
                  The digestive tract of animals reflects their ability to handle plant or animal proteins. Carnivores have shorter guts and they have to take proteins from animals, while herbivores have fermentative guts able to digest plant proteins. To be honest, even ruminants are not theoretically vegans, since they digest their gut bacteria as “animal” source.
                  You are denying the evidence of nature. If any animal is able to eat plants, why speciation occured?
                  Of course you vegans can’t understand it since your dogs and cats are vegan too.

                • All the grumpy mountain goats that you have consumed, have affected your grumpy levels. All the excess protein you are consuming is making you myopic and automatically dismissive of any other science to the contrary of what you believe.
                  I suggest less animal protein might level out your dogma.

                • You just love your myth. You were actually found out, when you used the term, complete protein, this nutritional clap trap has been roundly dismissed in the last decade as a myth, mostly created by vested interests. Your studies and knowledge are out of date,

                • Yes, the laws of nature are indeed outdated, and logic either. No need to argue anymore…this post is self commenting and perfectly enlights the vegan religions. We have to respect it as we respect the new religion to sake Maradona

                • As it happens I am a life long vegetarian. Your, almost religious dogma, and dismissive attitude regarding vegans is indeed also “self commenting”. No need to argue anymore? Good.

                • You always go on with mocking the others to have myths or outdated science while you are not able to provide any single reliable evidence to support your hypothesis.
                  You go on with linking vegan sites as sources, like they were bibles

              • “We don’t have herbivores digestive tract, thus we are not able to completely digest plant proteins.”

                This is an absurd argument. I can also make the same argument that we don’t have a carnivore’s digestive tract, which is actually closer to the truth. Our stomachs, intestines and colons are way closer to herbivores than carnivores. And omnivores tend to be closer to carnivores.

                Also, it depends on the plant protein. For example, unfermented soy is a indigestible protein. But in general, good forms of plant protein will be more easily digested than good forms of animal protein. In fact, to better digest animal protein it should be paired with non-starchy vegetables. Protein requires more acid and starches require a more alkaline digestion.

                Furthermore, high heat cooking methods of meat and animal protein ruin your ability to properly assimilate it because they form advanced glycated end products, which are difficult to metabolize.

                • If you compare our digestive tract is a middle way between carnivores and other primates. Are you aware about Leslie Aiello? We had to rely on meat to raise our big brains and our gut shrank as consequence.
                  You totally ignore the comparative physiology of animals, there are some good books about the argument, otherwise it just takes to read dr.Cordain’s articles about the issue. Why he’s not certainly a God and may be not 100% right on all, the comparative physiology and hunter gatherers studies are masterpieces.
                  anyway if you want I can give you some lessons about the issue…

                • COOKING of foods is the hypothesis we got bigger brains, which led to more nutrients and calories, and meat was suggested as the most likely food. Newer research points to starchy plants.
                  Are you aware of Dr. Karen Hardy’s research from last year?

                  As for physiology, the question is, have we fully adapted internal structures and metabolism that are in harmony with eating meat? I really found this fascinating and I truly thought it made sense that yes, we probably did to some degree, so I started looking at comparing our own anatomy, physiology, digestive capabilities with that of other omnivores, carnivores and herbivore/frugivores.

                  What you find is that omnivores and carnivores are generally 90%+ similar in these respects and herbivores/frugivores are likewise 90%+ similar. And when we analyze humans we find they fit the description closer to herbivores/frugivores. There is some pretty significant analysis for this in my opinion.

                  Omnivorous animals all share traits with carnivores. Such as intestines length, the smooth or rough nature of the gut (carnivores are smooth, ours are rough), the saliva content (carnivores have acidic saliva, ours doesn’t and ours only has digestive amylase in it), our teeth and the list goes on and on and on.

                  Just because humans can eat like omnivores, doesn’t mean we must therefore be omnivores. This is of course false because mere behavior doesn’t indicate suitability.

                  We can definitely survive on meat and that’s exactly what we did. However it’s a second rate meal that promoted disease and shorter lifespans, as it does today. When we started eating meat it is clear that we had weaker bones and disease. The ancient greeks even spoke of this. Have you read the Hippocratic writings or the works of Plato and Pythagoras who predicted the eventual decline in health due to usage of grains and meat in the diet? Yeah. They were the same “crackpots” who said “first do no harm.” Imagine that.

                • Thank you for this, very illuminating and indeed, a fascinating approach to this whole dilemma. Congratulations on presenting a balance of history, anatomy and most of all, without slagging off someone else’s belief system. Many thanks.

                • That cooking made us human is a very weak argument still when debunked by Cordain, and even Lieberman, ironically colleaugue of Wrangham, found that it was about slicing meat, not cooking tubers and veggies.
                  The curve of brain development was already at the exponential increment when we started to domesticate fire, thus it’s highly unlikely that it was about that.
                  and here’s the latest evidence
                  http://thepaleodiet.com/archeological-breakthrough-indicates-hominin-predecessors-were-sophisticated-hunters/

                • This isn’t “evidence” at all. Its conclusion references hunters and animal consumption. There is no proof that this consumption was a major part of the diet. Just that it occurred.

    • Is it possible that vegans are so stubborn in their beliefs because they don’t get enough DHA and EPA? Talking to a vegan is like talking to brick wall.

      This is called a positive feedback loop in engineering, or a vicious circle in common parlance. Not a good thing. It means that they cannot get out of their trap until they get much sicker.

      But that is just a theory.

      • Yeah, Bird. That MUST be it!

        That or you lack the intellectual stability to maintain a scientific discussion outside of your comfort zone, and your perception can’t handle it.

        But yeah, we’re all just stubborn individuals who’ve gone down the closed minded path of normal.

        • Oh, my goodness. All this hostility. Hostility is one of the symptoms of veganism. I love the fact that vegans have compassion for all animals but hate everyone who disagrees with them.

          • Given that you must have been talking to brick walls at some point, so as to have a comparison between them and vegans, might you be up for some alternative supplements? Ones that are able to help you distinguish between humans and brick walls?

      • Yes, indeed, there’s a cognitive decline with the lack of DHA and other crucial nutrients.
        It probably enworse their collective delirium.
        Maybe, since they are able to deny the evidence, they can claim to be healthy even in point of death.

        • It is time for some more Sicilian grumpy goat protein for you. Obviously you haven’t had enough animal in you recently, as your replies are losing their usual caustic sarcasm.

    • Comments from first-time commenters need to be approved first. I see that your comment appeared below after it was approved.

      The only comments we delete and do not publish are those that contain personal attacks and are not constructive or don’t add to the discussion in any way.

  13. “I summarized research indicating that vegetarians, and particularly vegans, have lower levels of EPA and DHA than omnivores” This is a quote from chris’s article.

    The fact that you *summarised* this and may or may not amend the information at a later date, might be borderline irrelevant to millions of people like myself.

    I have been a vegetarian all my life bar the first few years.
    I am over 60, full time gardener, cyclist, climber, walker, logger in winter, sailor and won’t be considering taking supplements at all.

    Although this is obviously anecdotal evidence and only pertinent to many millions like me, suggesting vegetarians and or vegans should supplement is, in my view, totally missing the point that millions of us vegetarians just don’t need them at all.

    If I can’t go by my own experiential evidence, which I would rather trust, than with the endless suggestions and recommendations of endless health practitioners, I should be taking, perhaps, dozens of supplements, none of which I need.

    My food suffices, even if yours doesn’t. This does not equate to you requiring supplements, on the contrary, it may require that as a consumer of any food regime at all, it is that which might be examined, before you are palmed off with something you just might not need at all.

    Those that just might, I wish you good luck with your choice of a replacement, in this world of charlatans and so called health suppliers, where barely a real, food grade supplement. exists.

    • Sorry you have all the answers. Must make life really boring.
      To be scientific, which is to be curious, is to be open to the world. If DHA is essential to the development of the brain and especially the retina of the neo-nate, then your attitude would put a large number of babies/people at significant risk. The kicker is that some people might make enough DHA from ALA by a mechanism or larger activity of that mechanism than we currently understand. There is precedent, finding some DHA even in people who eat foods that never went near an ocean. The consequences of being unable to make that conversion could make one surprisingly smug.

      I am a psychiatrist, and I have a small question. If you are doing so well, why are you reading Chris Kesser, and why would you mock others for trying to improve their health?

    • This comment is the perfect example of the saying “You can’t fight faith with facts.”

      This is why I never try to convince anyone that they should follow a particular diet. Most people don’t base their choices on facts; they base them on something else entirely.

      My job is to provide the evidence-based information. It’s up to each individual to do whatever they will with it. If the response is “none of that evidence applies to me”, well, there’s always the possibility that you’re correct, and I wish you the best.

      As I said in the article, there are differences in genetics and other factors that make it possible for some people on plant-based diets to be more efficient in converting precursor nutrients to their active forms, and that explains why some vegetarians and even vegans can thrive (though every vegan I know that is thriving does supplement).

      • Had you considered Chis, just for one moment, that your title for this topic, “Why Vegetarians and Vegans SHOULD Supplement with DHA” might have instead been.

        Why Vegetarians and Vegans MIGHT NEED to Supplement with DHA, you wouldn’t have to defend your stance when people tell you that they don’t need to supplement.

        What we SHOULD do is not for you to say.

        As for the FAITH quip, my experiential observations have nothing to do with faith, they are born out of experience.

      • Being able to deal in someway is not thriving. If you have to supplement, aside maybe from vitamin D and something to fix temporarily issues, it means that it doesn’t work. Because we are not cows or rabbits, we don’t have 4 stomachs, we don’t have very fermentative guts either. Even chimps are not vegan. Have you seen videos of chimps fighting for a prey? They are probably 90% plant based, but not vegan at 100%.
        And supplements are not real food.
        How can you say that they thrive?
        Based on a couple of blood markers in the short term?
        It takes much more as you perfectly know. No traditional population known was vegan. Okinawas and Kitavans ate less animal products, but far from being zero.
        We have to define HOW much someone is able to convert plant products.
        If you compare a man without hair with a half haired one, you can say that the latter has plenty of hair, but what happens when you take one with actually plenty of hair?

      • The most likely hypotesis is that we became humans thanks to meat consumption, otherwise our primate brain would never have grown.
        In light of that, we released the converting features getting more or less like cats in some metabolic patways. Thus, to thrive on a vegan diet, we should go back even at a previous step than chimps, since they are not vegan either, becoming another species, a farcry..

  14. Hi Chris. I have heard vegan Joel Furhman say that the optimum diet is a plant-based vegan diet with DHA supplementation. Is there room for agreement about that? Thanks so much

      • Thank you – you’re the best. This article is very helpful. I often get persuaded by the promises of a vegan diet so hopefully this keeps me on track.

        • Just keep in mind that your genes have been selected for millions of years from ancestors who eat meat and needed meat in order to survive. There were NO vegan paleolithic folks.

          • Fun fact: this isn’t the ice age. If you think your body or your food is the same, then you have a lot of reading ahead of you.

          • So true. What are your thoughts on the Blue Zones? This always stumps me – those folks eat little meat, eat lots of beans, legumes, whole grains. Also the 7 Day Adventist folks. Not paleo and living well and long. Thank you for your thoughts.

            • SDA’s aren’t into boozing, smoking and taking drugs for the main part. These are confounding factors for influencing longevity.

              • They actually did some studies within their group called the Adventist Health Studies. One of them showed:

                “-Reducing consumption of red and white meat was associated with a decrease of colon cancer.
                -Eating legumes was protective for colon cancer.
                -Eating nuts several times a week reduces the risk of heart attack by up to 50%.
                -Eating whole meal bread instead of white bread reduced non-fatal heart attack risk by 45%.
                -Drinking 5 or more glasses of water a day may reduce heart disease by 50%.
                -Men who had a high consumption of tomatoes reduced their risk of prostate cancer by 40%.
                -Drinking soy milk more than once daily may reduce prostate cancer by 70%.”

                SDA’s actually vary as to whether they are vegan, semi vegetarian, pesco vegetarian, or meat eater. This study showed that the non-meat eaters lived longer. And those who are strictly vegan tend to do even better than their nearly vegan counterparts.

                Vegetarian dietary patterns and mortality in Adventist Health Study 2.
                http://www.ncbi.nlm.nih.gov/pubmed/23836264
                “Vegetarian diets are associated with lower all-cause mortality and with some reductions in cause-specific mortality.”

            • They eat less meat, not zero meat!
              Furthermore, the book is a personal biased interpretation of fact.
              Indeed, traditional Okinawas ate pork and tubers, not rice.

              • And Sardinians (I’m Italian and perfectlt know), ate plenty of sheep and goat meat, pork and some pecorino cheese.

              • I think you’re the one with personal bias. The traditional Okinawans ate about 1% of calories from fish and <1% from meat. They ate 12% from rice and almost 70% from sweet potatoes. If you think this is justification for consuming a lot of animal products then you're deluding yourself.

                Go to table 1 for diet breakdown.

                https://www.researchgate.net/publication/5859391_Caloric_Restriction_the_Traditional_Okinawan_Diet_and_Healthy_Aging_The_Diet_of_the_World's_Longest-Lived_People_and_Its_Potential_Impact_on_Morbidity_and_Life_Span

                The idea should be to focus on getting to the healthiest reasonable diet that is able to be adhered to. There's virtually no difference health wise from being 100% vegan vs. eating tons of plant foods and then having small amounts of animal foods, which make it easier to get a few nutrients here and there. Key word: SMALL.

                The groups that consume the least amount of animal products live the longest. The cultures that historically rely on much meat, eggs, milk and fat do most poorly. For example the Inuit, who in contrast have the lowest life expectancy and disease is rampant in their world, yes even their traditional and historic examples, eating 100% organic, unprocessed animal food.

                • Really interesting. Thank you John. I struggle with this information and I appreciate your thoughts. I feel my best on a “paleo” diet though I can’t stand that term and I get tired of the limited food choices.

                  But I do see that there are no real long term studies on longevity rates for paleo adherents but there are long term population studies that support very low if any animal consumption. That said I feel horrible on a low protein, higher carb diet like a Blue Zone diet. And I gain weight! What gives? Any advice for this? Thank you!

                • Don’t believe to scams…there is evidence from about 230 tribes of hunter gatherers, most of them getting more than 50% of their caloric intake from animal food.
                  all of them disease free…
                  Don’t listen to their delirium, I perfectly agree that under selective pressure someone may be more efficient to process vegetables stuff, but under the boundaries of a species.
                  thus, a race may do well with 20% of meat while others may need much more. Nobody vegan, neither chimps!!

                • Download for free the PDF of Hillard Kaplan’s work: A theory of human life history evolution…
                  don’t listen to weak vegan fables and tales

                • Indeed indians are so well adapted to a vegan diet that 70% have severe nutritional deficiencies…see my aforementioned link, directly from “times of India”.
                  And FAO is pushing fortified food to avoid malnutrition…and it’s not a matter of undernutrition as stated in their official documents

                • Hi again John – what are your thoughts on nutrient density – a Joel Furhman approach v an approach that Chris outlines above? Thank you!

                • What foods are you eating on paleo and what are you eating that makes you feel horrible? When that happens and you gain weight that sounds more like a processed american diet. When you eat whole plant-based foods, – veggies, fruits, legumes, and whole grains, you usually lose weight.

                  And I know how you feel about meat making you feel good. You are used to getting much of your calories in the form of protein/fat and so your body becomes used to this.

                • I eat a super clean mostly non starchy veggie diet on the Paleo plan. A little pastured meat and wild fish. Not much else. I feel great on this but its crazy boring. I enjoy ethnic foods and feel very persuaded by the Blue Zones/Joel Furhman way of eating (low protein, IGF-1 considerations, etc). When I eat a BZ kind of diet I am eating again super clean – lots of veggies, lots of beans, quinoa, hummus. I feel foggy headed, hungry, and bloated and I lose muscle.

                • Yes there indeed are cultures who remain/remained healthy on such high fat and meat based products. However, no culture which predominantly consumed high fats or meats as their staple has had any semblance of longevity.

                  As I said, the Inuit for example are notorious for short lifespans. Although they do not die of heart disease, or even cancer, very often…they do die as a general trend, much earlier (by decades) than surrounding populations. The traditional one’s lifespan was no longer than an average of 45-50 years. They didn’t live long enough to get cancer. But they do have very high rate of rheumatoid arthritis, systemic lupus erythematosus, connective tissue diseases, and the highest rate in the world of spondyloarthrosis.

                  Same goes for the Maasai in Africa. Short lifespans. They consume raw milk and meats. They also tend to get osteoporosis quite regularly.

                  And before you consume all that fat and meat, you should know the Inuit most likely have genetic adaptations that allowed them to do better on a high-fat diet.

                  The Secret To The Inuit High-Fat Diet May Be Good Genes
                  http://www.npr.org/sections/thesalt/2015/09/17/441169188/the-secret-to-the-inuit-high-fat-diet-may-be-good-genes

                • First of all, average lifespan is different from life expectance.
                  Almost all the hunter gatherers who didn’t die at birth or for an accident in childhood, lived as much as we do nowadays, but quite disease free.
                  Second, the Inuit example is an extreme one, and yes they had a selective pressure to handle such extreme conditions better.
                  They lack of sun exposure, etc..etc..
                  Nobody here is claiming to eat like a Inuit, also because it’s not possible here, and veggies for me are really important, I’m not a fan of very low carb diets either. Nevertheless, though the extreme meat eaters managed to live well, there’s no example of vegan tribe in human history.
                  They went from 20% to 99% of the caloric intake from animal food, but nobody without!

                • As for India, they are not vegan, about 30-40% of them are vegetarian. And that usually means they are lacto-vegetarians (eat dairy products such as milk, etc). I have no idea where you are getting your info from.

                  https://en.wikipedia.org/wiki/Vegetarianism_by_country#India

                  And you cannot categorize people like that. Most vegetarians/vegans are unhealthy and uninformed. They make choices solely based on animal cruelty. Which I find nothing wrong with, but they don’t understand nutrition at all.

                • I actually tend to take an approach very similar to Dr. Fuhrman, which is, I stress and promote a high micro-nutrient rich diet. Nutrient dense foods give you the most nutrients for the fewest amount of calories. Plant foods are the highest in this respect. This is best obtained with a plant-based diet high in raw foods, berries, dark leafy greens and cruciferous veggies and fresh fruits as a base. The foods I cook tend to be starchy veggies and occasionally I’ll eat salmon or shrimp but that’s rare. I avoid dairy of any kind and refined grains. You don’t have to do that exactly, as many PBD doctors allow fish and low fat dairy (Ornish), eggs (Fuhrman) or even some meat on occasion (McDougall) etc.

                  Organ meats? Are we predators? The wild animals that go for organ meats are predators, not omnivores. And of those, ALL of them have the ability to for instance detox active vitamin A. And get rid of excess cholesterol. Humans cannot do this. It’s a moot point.

                  The low carb crowd constantly uses the notion that these animal foods represent “nutrient dense” calories. But they never mention WHICH nutrients. Yes they are high in vitamin A. So high, in fact, that you can get too much. Yes they are high in iron, so much so, that you can get too much. Yes high in saturated fat, so much so that you can get too much.

                  Kresser even mentions in the video that there had to be all kinds of caveats to put organ meats at the top. Calories, saturated fat, sodium… yes these are things you don’t want too much of. And then fruits and vegetables would be way higher if you didn’t remove, oh you know, PHYTOCHEMICALS and ANTIOXIDANTS. I guess Robb Wolf doesn’t think these are that important. They are very important and guess what foods have low levels, if not nonexistent levels of antioxidants? ANIMAL FOODS. Which is why they need to be eaten raw, on the spot. You kill it, you eat it immediately and you eat the blood, the liver, the stomach, and some of the muscle as well. You don’t store it, cook it later, salt it, season it, etc.

                  But yes if you’re gonna eat meat, eat organ meats, because what most people eat is the muscle, which is the most nutrient POOR, and the most likely to have all kinds of pesticides, herbicides, antibiotics etc in it. Most of the time there’s no reason to because virtually every single mineral, vitamin, compound that we can get from meat, we can get from plant foods. If you are deficient in something, then yeah a little bit of animal foods may help with things like b12 and some other nutrients. Or you could just supplement.

                • Please for nutrient density take the table that Lalonde made a while back.
                  The delirium is reaching its top…
                  If you want to be a prey, good for you, I’m a predator, carnivore frugivore like bears and boars.
                  beware of the predators when you are grazing!

                • Christy- It’s hard to diagnose the problem but you basically are gonna have to do a trial and error. The bloating is most likely caused by eating a lot of beans. The way to prevent this is soaking the beans. Google it to find out more.

                  You could also have a food allergy to grains for instance and might wanna get tested. Some people can have wheat allergy, gluten can be very harmful in celiac patients, and there are potential drawbacks of some grains some of the time. All the more reason to figure out which is bad and which is OK for you. For the vast majority of people, whole grains are perfectly fine and perfectly healthy. And great sources of fiber, vitamins, minerals, etc.

                  It also sounds like an issue of carbs. You are not getting enough carbs, and more importantly calories/energy. You will feel more satiated consuming meat and fat. Plant foods are less calorie dense (especially veggies).

                  So you WILL have to increase your portion sizes a great deal for certain plant foods in comparison to the other foods, BUT it’s kind of like a visual illusion because it’s mostly water volume (which is absolutely necessary btw, and a good thing). It just makes it appear as though there is more volume being eaten.

                  This is a problem because many people respond to portion sizes, not just calories. And this is why it’s easy to lose weight on raw foods. You eat a plate full of fruits and veggies and mentally you feel like you should have just gotten the same calories as a plate full of steak and potatoes. Not so. You would need 2-3x more food to equal it with raw food.

                  Also, if your goal is a variety of foods then you may have to sacrifice health to some degree. But you can stick with the healthiest plant foods that are more calorie dense – fruits, starchy veggies (potatoes etc), nuts, seeds, legumes, and whole grains.

                • Yes life expectancy is obviously more important. But our early human ancestors were not eating lots of meat.
                  “Human Ancestors Were Nearly All Vegetarians” -Scientific American

                  Depending on which arbitrary period you decide to choose to zero in on, yes you can find periods of time where our ancestors were eating more animal foods. These were times of scarcity. Obtaining animal foods is always much more risky and unpredictable than gathering and foraging. And this was our default. Our bodies resemble this. Our physiology corresponds to this.

                  “there’s no example of vegan tribe in human history.”

                  This is not a question that actually wants an answer. This is intended to be a conversation closer. Question asked when one has formed their opinions before examining the evidence. But no I am not aware of any indigenous tribe or culture that has relied solely on a vegan diet.

                  If we are interested in the merits of vegan diets however, or just plant based diets in general, the questions would be quite different. For instance “as any given culture’s diet more closely approximates a plant-predominated intake, do they live longer and have better health?” The answer to that is a resounding and loud yes.

                  Once again, the longest lived culture we know of is the traditional Okinawans in the early 1900’s. That link you posted was describing the more MODERN Okinawans in the 1970’s. They indeed did eat pork but you forgot this part:
                  “However, pork is primarily only eaten at monthly festivals and the daily diet is almost entirely plant based.[7]”
                  They have been becoming more modern over the years. Today they are the fattest of the Japanese and now have KFC’s. Lol.

                  Anyway, when we ask about if any culture was 100% vegan the answer is absolutely 100% no. Animal food does have nutrients and obviously calories. So it represents an option. Especially in times of scarcity. But the big picture look at things reveals that the less of that we eat the better. As I said, interesting studies on 7th day Adventists corroborate this.

                  I hope you get my point though. No, not everyone needs to be vegan. Just like not everyone needs to abstain from alcohol 100%. Just all I am asking is that we don’t go around trying to justify drinking alcohol as though it’s good for us in terms of health. And likewise with nutrition. Nutrition is a science, it’s not an opinion poll.

                  That doesn’t mean there isn’t individual variability. There is. Lots of it. But I see most people interested in using that phrase as again, an excuse to end discussion, not clarify it.

              • In fact, many SDA’s eat no meat at all including 102 year old, Dr. Ellmsworth Wareham, who was still performing surgical rounds at age 95.

  15. Thanks for this insight into the importance of DHA, and the almost certain shortage that vegetarians an vegans may suffer, Chris.
    I want to add that, from my recent studies, the vegan body seems to be aware of this shortage, and takes great pains to derive as much DHA as possible from the ALA that is provided. That doesn’t mean there may not still be a shortage at times, even usually. It does mean however that the human body senses what it needs, and does convert ALA to DHA in higher percentages than you will find in a typical “omnivore”. There are studies that show vegans routinely having double the conversion rate of omnivores.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257695/

    http://www.nutraingredients-usa.com/Research/Omega-3-ALA-intakes-enough-for-EPA-DPA-levels-for-non-fish-eaters

    Notice in the second article, vegans actually ended up with more DHA circulating in the plasma than any omnivore group, even though their intake was zero.

    You might want to review the information from these studies for validity and possibly use some of it to enhance your “Reduced Conversion” section of this article.

    • At the end of the day what matters most is the average levels of DHA in serum amongst omnivores vs. vegetarians and vegans. Everything else is just speculation on mechanisms. And what the studies clearly show is that in virtually all populations omnivores have higher levels, and that DHA intakes are likely below the optimal levels in vegetarians and vegans.

      The studies you linked to only further highlight the importance—and perhaps essentiality—of DHA. If someone isn’t consuming it, the body will do everything it can to accelerate conversion of ALA. Likewise, women are better converters than men because DHA is so crucial for fetal development that women have evolved to be more efficient at this process. Note that this is only true for *young* women, which strengthens the argument that this is an evolutionary mechanism.

      • I recall that many anthropologists claim, with no dietary political ax to grind presumably, that human beings could not have developed such a big brain if they had not first learned how to obtain sufficient animal-based food.

        I hear the call of compassion, so I eat as low on the animal evolutionary ladder as possible, like fish. And I have no compassion problem with milk and eggs. I buy eggs from a free range farmer dude who brings the four cartons per week (for 3 people and 2 dogs) to my door. These chickens are loved and would never see the light of day if we did not eat their eggs. Same with milk and honey. But compassion demands that I do not give human beings a hard time if they put beef or pork in front of me and expect me to eat it.

        • Do you have compassion for plants. They are living beings as well and the latest studies shown that they do suffer when you eat them.
          At this point you can try with stones or maybe soon vegans will be able to complete the photosynthesis, since they can evolve quickly 🙂

              • you claimed in your previous post that

                “latest studies shown that they vegetables) do suffer when you eat them.”

                I pointed out that my vegetables don’t suffer when I eat them, for obvious reasons.

                Your studies are either inaccurate, misquoted or misrepresented.; as it is untrue that my vegetables suffer when I eat them.

                May I suggest you look at studies that understand grammar and sentence structure. This way they won’t appear flawed.

                Your steak is none of my concern.

        • I addressed this in the article. There is plenty of evidence showing that higher DHA levels are associated with better outcomes in terms of cognitive, neurological, and cardiovascular health.

          It’s easy to cherry-pick a single study that supports your view.

          • Right, but I think you are making a leap and assuming just because higher levels are better for the general population (maybe they need more) and vegetarians tend to have lower levels than omnivores, that means “DHA intakes are likely below the optimal levels in vegetarians and vegans.”

            I think you would need evidence that vegetarians (not just the general population) are negatively affected by lower intake, especially since they tend to have better cognitive, neurological, and cardiovascular health than omnivores (yes I know there are other confounding factors).

            If I’m cherry picking, please link studies showing that vegetarians have adverse effects with lower DHA intake.

          • I think that serum levels may also be misleading.
            What about the actual amount properly embedded in cellular membranes.
            We have to choose given the evolutionary and antropological evidence TOGETHER with trials, to make a puzzle, not cherry picking.

  16. Thank you for this article. I’m interested to also know what other deficiencies might be lurking in a vegan diet. i used to be vegan but am now experimenting with Paleo. Are legumes such a problem eg hummous? I keep off soya now. But what about pea protein?
    My further question for you other readers is could a vegan who is crabby, rigid and argumentative be suffering brain inflammation due to insufficient DHA?

    • Hi Tara,

      Check this article out which reviews the potential nutrient deficiencies on a vegetarian/vegan diet. https://chriskresser.com/why-you-should-think-twice-about-vegetarian-and-vegan-diets/

      I can tell you from my clinical experience having treated hundreds of patients, that nutrient deficiency is definitely more common in people on plant-based diets, though of course it can still happen in omnivores (especially when gastrointestinal malabsorption is present).

      And yes, I think it’s possible that a lack of B12 and/or DHA, along with other nutrients like iron and zinc, can adversely affect cognitive function and mood.

      • With all due respect, your small practice cannot be generalized in the general population.

        I do think think we are experiencing a problem with people being raised on very animal-based/centered diets, going plant-based without any real nutrition education at school or from parents that help them.

        Living in Bay area, at one time, amongst many traditional (from childhood) plant-based eaters, here in US working with visas, from a variety of countries: China, India, Africa, Denmark, etc…

        These eaters knew instinctively what to eat by cultural norms. Their traditional meals always included plentiful amounts of legumes (beans, lentils, peas, fermented soy) paired with whole grains and some starchy veggies. These cultures also include seeds and nuts and, things like seaweed (source of EPA), and yes, sometimes eggs, fish, chicken were used like condiments added to dish, not served as the entree, beef and dairy not on the menu.

        Legumes, grains, starchy vegetables are the staples of a plant-based diet for calories and protein; the vegetables and fruits provide lots of nutrients, but not the bulk of the calories, b-vitamins, zinc, etc. .

        It is sad that the vegan parents mentioned on this site, with undernourished, kids. If it is the case I am aware of, the parents were trying to be healthy by feeding their kids tons of fruits and vegetables; they did not have the knowledge from their own health class in school or from pediatrician or traditional plant-based eaters or other resources, on the need for legumes, grains, starchy vegetables and sources of omega-3’s, such as seaweed, chia seeds, flax seeds and flax oils for plant-based including vegan diets. We need education in schools about all diet types, people might experience as adults!!!

        What, at least the EPIC Oxford Study shows, with tens of thousands of people studied, vs. your client pool is vegans were not getting RDA for calcium, iodine, and B-12. ( I don’t believe they tested blood DHA levels in this particular nutrient study).

        So I would shout out to plant based eaters, like me, to take your B-12, eat your chia seeds, bok choy, broccoli, lucinato kale (tasted better than curly) and collard greens (cook them and try splash balsamic vinegar-won’t regret it!), fortified plant milk, and iodized salt and nori seaweed (add it to stir fries, soups, homemade veggie burgers…) for iodine or take supplement in safe amount-see vegan sources like Brenda, Davis, vegan dietitian.

        Nori seaweed can also up your EPA, only one step away from DHA and also adds iodine, or with green light from doctor an algal supplement at SAFE dose.

        For omnivores, they did not meet RDA for these nutrients: calcium, iodine, magnesium, vitamin C, vitamin E, calcium fiber and folate.

        A recent study of those on a Paleo diet, Paleo dieters had low levels of riboflavin, thiamin and calcium. Also, if going low carb (reducing fruits, legumes and grains) will also give you much decreased intake of magnesium, fiber, resistant starches, pectin and vitamin C.

        http://nutritionfacts.org/video/omnivore-vs-vegan-nutrient-deficiencies-2/

        https://mic.com/articles/146162/paleo-diet-may-be-linked-to-major-nutritional-deficiencies#.Q8GIjou

        • From memory the article said the paleo folks were just under the RDI for thiamine at around .9 versus 1.1, and a bit over the RD1 for riboflavin (which is found in dairy products). I’ll keep eating my vegemite. 10g or 2 servings/day should do it.

    • “could a vegan who is crabby, rigid and argumentative be suffering brain inflammation due to insufficient DHA?”

      Perhaps you are crabby, rigid and argumentative simply because that is in your nature to be so.

      • “just your nature” has no meaning. A person with a crabby personality with determination can build new pathways in their brain for a cheerful, friendly, etc. personality. And it is easier if they get the right nutrients. So, one’s nature is dependent upon the choices and actions that one has made in the past, and they can change their nature by practicing different choices.

        • No one is saying they can’t. Except that you have chosen to infer, that which I have not implied.

          Her biography may well have become her biology, no one said she couldn’t change it, or her nature, which, to some, has meaning, even if not for you.

    • Alright, i have a huge list of references to go along with this but i will only post the individual nutrients themselves because my whole copy and post (which i wrote myself, not a rip) is 1000 words long, i can post it if you want me to but i would prefer to not. Anyways there is Calcium, Vitamin b12,
      Choline, Glycine (semi essential), iron and zinc (both are poorly absorbed from plants) Creatine, dha,
      Taurine (conditionally essential), k2 and vitamin a (several people dont convert provitamin a carotinoids well, beta carotene metabolites also have anti vitamin a properties so the poor conversion may actually have poorer effects. IMO, beta carotene and retinol have different benefits so its a good idea to get both)

  17. i would be interested know peoples thoughts on a few things i read along the lines that…
    DHA is best when in the “sn-2” position (basically the middle of a triacylglycerol or phospholipid).
    eg. from here; caloriesproper.com/vegetable-oil-fatty-acids-are-not-essential/
    1) DHA is more stable in this position (eg, Wijesundera et al., 2008).
    2) It’s more bioavailable here (eg, Christensen et al., 1995).
    3) sn-2-DHA is more effectively incorporated into brain lipids (eg, Thies et al., 1994 and Lagarde et al., 2001). Again, it’s not all-or-nothing, but more is likely gonna get in your brain if you eat seafood.

    I have also read ~ ‘DHA in the sn-2 position in phosphoglycerides is the predominant form in mother’s milk. It is the form that is required for optimal brain development in nursing infants’

    • also for the same caloriesproper.com site;

      “This [DHA in sn-2 position] is how DHA is present in seafood but not always in fish oil supps (eg, Litchfield 1968 and Ando et al., 1996).”

  18. I enjoyed this article. I am an omnivore and eat the fish that you recommend. Good to reinforce that I am on the right track. My health has been excellent and has gotten much better since I started that fish eating regime

    • Continuing.. Especially my HDLs which shyrocketed from 42 to 64.. Would be related to eating more fatty fish or could also be related to my losing 30 pounds :-). Not sure. Chris, do you have input to this.. Just curious

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