Dispatches from the 6th International Congress on Vegetarian Nutrition

Should vegans and vegetarians take supplements of EPA and DHA omega-3s?

By Elaine WATSON

- Last updated on GMT

Related tags Omega-3 fatty acid Epa

Should vegetarians take supplements of EPA and DHA omega-3s?
If they don’t eat fish, vegans and vegetarians get very little EPA and DHA, the long chain omega-3 fatty acids we are told are key for maintaining cardiovascular and cognitive health. But is this a problem that needs to be fixed? And are algal omega-3 supplements the answer?

The jury on this question appeared to be out at the 6th International Congress on Vegetarian Nutrition at Loma Linda University this week, in which delegates were told by successive speakers that vegans and lacto-ovo vegetarians (who don’t eat fish) are significantly less likely than their non-vegetarian counterparts to develop heart disease, despite their low - or zero - intakes of EPA and DHA.

There is also no evidence that vegans and vegetarians are at higher risk of depression, Alzheimer’s disease or other cognitive problems, delegates were told.

There are clearly independent health benefits for ALA which often times get overlooked

The cardio benefits of a vegan or vegetarian diet could be attributed to the fact that they typically eat more fiber, less saturated fat, and fewer calories as well as consuming more cardio-protective phytochemicals, plant-based healthy fats (including the omega-3 fatty acid alpha-linolenic acid or ALA from walnuts, flaxseed and other sources), said researchers.

But should they still take EPA and/or DHA supplements? Or is eating a lot of ALA - which the body is very inefficient at converting to EPA and DHA - sufficient?

While most of the literature about the cardiovascular benefits of omega-3s is about EPA/DHA, there is some evidence that ALA has heart health benefits beyond its impact via the conversion to EPA and DHA, said Sujatha Rajaram, PhD, associate professor in the Dept of Nutrition at Loma Linda University.

There is some evidence to suggest a role for ALA in reducing the risk of coronary heart disease and type 2 diabetes.

“There are clearly independent health benefits for ALA which often times get overlooked”, ​added Dr Rajaram, who has conducted several studies exploring the relative impact of walnuts (which contain ALA) versus fatty fish (which contain EPA and DHA) on biomarkers of cardiovascular risk. (Click here​ for details of a study she co-authored that showed walnuts can lower LDL cholesterol).

The evidence does not justify advice to vegetarians and vegans to consume long-chain omega-3 fatty acids

Dr Tom Sanders: 'The evidence does not justify advice to vegetarians and vegans to take long-chain omega-3 fatty acid supplements'

Dr Tom Sanders, a professor in the Department of Medicine at King's College in London - who also noted that arterial ageing as measured by arterial stiffness “appears lower in vegans than in omnivores” -​ said he was not convinced that vegans and vegetarians should worry about their low or zero EPA/DHA intakes.

Meanwhile, studies suggesting that high dose DHA supplements could raise LDL cholesterol made him “a little nervous​” about recommending that vegans and vegetarians rush out to buy algal DHA supplements, he said.

While some vegan and vegetarian organizations actively recommend​ that these groups take supplements, “present evidence does not justify advice to vegetarians and vegans to consume long-chain omega-3 fatty acids”, ​claimed Dr Sanders.

The Vegetarian Society​ is rather agnostic on this issue, however, noting that, “If, as a vegetarian you want a source of DHA and EPA then there are a number of vegetarian supplements available.”

GOED: Everybody needs to get omega-3s in their diet… and the most efficient way will always be to consume EPA and DHA directly

Asked to comment on the issue, Adam Ismail, executive director at the Global Organization for EPA and DHA Omega-3s, told us: “Ultimately everybody needs to know their omega-3 status, and that should guide people on whether or not they need to increase their intakes.”

While vegetarians in general have lower rates of heart disease, he acknowledged, “omega-3s are important for more than just managing the heart.  They are really important in reproduction and development, managing the health of your brain and eyes, and helping maintain normal inflammation. So regardless, everybody needs to get omega-3s in their diet.”

He added: “Vegetarians are one of the groups that can convert short-chain omega-3s more efficiently than the rest of the population, but it ultimately comes down to your individual body which is why knowing your status is important. 

“The most efficient way will always be to consume EPA and DHA directly.

Even if LDL is raised, it is still beneficial to take omega-3s because of the other cardio-protective changes

Microalgae is a good source of long chain omega-3 fatty acids EPA and DHA that is suitable for vegans and vegetarians. The leading supplier is DSM. However, several other firms are poised to enter the market including Aurora Algae, which grows microalgae in vast open ponds in Karratha, Western Australia (pictured)

Asked to comment on Sander’s references to LDL cholesterol, he said: “In general, the increase in cholesterol is usually seen in people taking very high dosages of EPA and DHA.

“In addition, omega-3s increase HDL cholesterol levels and reduce triglyceride levels, which are beneficial effects that have to be considered in combination with an increase in cholesterol.”

GOED recently commissioned a Hazard Characterization on EPA and DHA from Spherix Consulting, ​one chapter of which analyzed the cholesterol studies, he said.

The basic gist is that even if LDL cholesterol is raised, it is still beneficial to take omega-3s because of the other cardio-protective changes.  Also, there is research to show that your omega-3 status is a better predictor of cardiovascular mortality risk than cholesterol or other markers used in CVD diagnosis.”

Spherix Consulting: A blood lipid profile change that includes a shift toward increased LDL, increased HDL, and reduced triglycerides would still be considered a favorable outcome

The Spherix Consulting analysis said more research was needed, but noted that “a blood lipid profile change after consumption of fish oil that includes a shift toward increased LDL, increased HDL, and reduced triglycerides (TAGs) would still be considered a favorable outcome, as lowered HDL and raised fasting levels of TAGs are considered cardiovascular disease risk factors (Cottin, et al. 2011).

“Authoritative researchers have suggested that the reduction in TAGs may be due to reduced hepatic de novo lipogenesis which, over the long term, might contribute to lower cardiovascular risk (Mozaffarian and Wu 2011).”

Click here​ to read more from the Vegetarian Congress on the benefits of plant-based diets on health.

Click here​ to find out more about findings of a 'landmark' new study on Mediterranean plant-based diets and cardiovascular health.



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Omega 3

Posted by Dr Dave,

Please be aware that "no evidence" may simply mean "no studies have been done" and not "it is not needed'. I sampled 100 vegan/vegetarians and their Omega 6/3 ratios are universally in the "unhealthy range" averaging 25% Omega 3 in RBC. This also does not mean they should take fish oil if they do not want. It does mean they need to increase their ALA intake and decrease their Omega 6 intake. Grains nuts and avocados and their attendant oils all contain higher 6's and lower 3's. If that is the basis of one's dietary fat then that needs to be reduced. Bottom line: check your levels and then plan your diet/supplementation. There is no need to fire blindly in either direction!

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Cholesterol Containing Creatures Maintain EPA and DHA

Posted by Dr Scott Doughman,

As a stakeholder in this arena of commerce and discussion (for algae oil supplement products) for algae oil omega-3s, please allow for some understanding of lipidology and kingdoms of life.
As we need not truly debate the face in the mirror, a cholesterol organism, we have indeed 1 billion vegetarians on planet earth.

Plants don't have cholesterol, so they don't have EPA or DHA. Any questions?

Sorry about that, but it gets your attention. Yes, we can say it may not be as important to have EPA and DHA in a low cholesterol/no cholesterol diet. But original whole milk has cholesterol and omega-3s EPA and DHA. Same with eggs. Not with plants and nuts. So are nuts enough to replace the 1% milk with little to no EPA/DHA? Certainly if it is soymilk, perhaps you don’t really need EPA or DHA. Seams rational. There is nothing wrong with it. Just say’in.

Now, since we are able to sustain as humans, with sustenance and sustainability close in prefix, to be sustainable is to have the capacity to endure. Fascinating how ALA and EPA are found at about equal levels in terms of magnitude of active fats in the body, perhaps EPA is higher. But DHA is 8x-10x higher than EPA and any other individual omega-3 in the total body. So that is how we are made.

Okay, now we understand the capacity to target both endurance and survival in the same sentence. A balance of fats and cholesterol is still at the discretion of the consumer to evaluate their own understanding of their own body. There are serious public health questions related to cholesterol medication use in a vegetarian and that cholesterol medications are for only heart cholesterol, but have no proof of cardiovascular benefits. This deeply means that the side effect of type 2 diabetes onset in an at-risk population is unknown compared to the normalized standard, pounded out statistics, meta-magnificent bases that have their place. They do not say if these populations, or any other population for that matter, are at risk. There is no hazard for omega-3s of any form, there are no knowledge gaps, really, just specificity. This is not sardonic, it is science. There are no known standards to evaluate the grand majority of diets and persons in a pro-vegetarian lifestyle or related cultures around our world.

When you eat sugar/carbs it raises the fat in the blood too, so cholesterol goes up, even in vegetarians and vegans. The human body is a cholesterol organism, even if it doesn't consume cholesterol in the diet. Therefore, for all those vegetarians and vegans out there with a perfect body to mass index, low carb diet, following all the methods in all the studies, you will be compared to the statistical basis. That basis is free for me to interpret as my own body is not in a fasted state when it needs the omega-3s.

At least that is where we all can meet, in the blood after a meal, sometime before we die. ALA as a fatty acid, has a biophysical nature that can impact lipoproteins in subtle and real ways. The total good fat cycling in the blood in the hours after you eat, these are considered more useful in my mind, than in the morning after fasting benefits of EPA and DHA. So "surf" (marine) and "turf" (meat) for vegetarians is not a counterbalance dietary method commonly practiced. The absolute system of direct activity in fats in lipoproteins is non-nutritive, it’s structure/function of the blood, and nutritive, benefits of cellular omega-3 index status.

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