The Need for DHA by Vegans

(note: this is a long article but important to read completely and understand)

Topics covered in this blog:

Why Blue Zones are not examples to emulate

Does DHA Cause Prostate Cancer?

The Importance of DHA Adequacy

So what do nuts and seeds have to do with omega-3 fatty acid adequacy?

The Link Between DHA and Dementia

DHA and Parkinson’s Disease

The Conservative Use of Supplements

The internet and our free marketplace can be a confusing place at times

 

Blue Zones – not examples to emulate. 

Some long-lived societies generally eat more plants and less animal products than other modern regions. However, most of them (except a minority of Adventists) still eat some natural animal products or seafood and are not vegan.  Protective factors in their diets have been noted (such as high vegetable and legume intake, no processed foods, low meat intake), however, these societies do not represent the ideal human diet. They eat foods that are grown locally, which of course is a good thing in one sense, but has the shortcoming of not taking advantage of the wide varieties of foods that are available to us today. These populations don’t have the opportunity to use the advances in nutritional science to construct a dietary portfolio of the healthiest foods in the world. We have an opportunity to do much better than the Blue Zones.

The percent of centenarians in Okinawa is 6/10,000.¹ Overall in the Blue Zones, less than 10 percent live past 90.² The life expectancy (after survival to 65) for Adventists in Loma Linda, CA  is 85 in men and 87.5 in women.³These societies live longer than the average Westerner, but that does not mean they have maximized health and longevity.

A Nutritarian diet, along with my supplemental recommendations, does not attempt to duplicate a Blue Zone. Rather, it significantly surpasses the diets of the Blue Zones by incorporating the most current research, such as what foods enhance later-life brain function and stem cell and telomere maintenance.

It slows aging by utilizing the protective substances in leafy greens and other nutrient-rich foods. The Nutritarian diet takes advantage of the latest findings in nutritional science; we do not attempt to replicate primitive diets or regional diets that do somewhat better than typical Americans—but rather extract the  most lifespan-enhancing practices based on scientific studies, with the goal of consistently and predictably extending human lifespan considerably further.  Since this diet enables people to live well into their nineties, I have the responsibility to protect and enhance brain health until 100. No one wants to live to be 100 and not have a fully functioning brain.  It’s interesting to note that the younger the average age of death, the less likely dementia will occur and as such, may not be as much of an issue.

Does DHA Cause Prostate Cancer?

Though deficiencies of nutrients can accelerate aging, and stem cell and telomere decay and even promote cancer, it is true that nutritional excess or overdosing with many otherwise important and health-supporting nutrients can also increase risk of cancer.  Using the link between nutritional excess of a substance and cancer is never a logical argument to allow deficiencies to exist. For example, excess vitamin D supplementation may increase mortality risk, but so may deficiency.^4-6

The link between fish oil and/or excess fish intake and prostate cancer has been suspected for years and I reported comprehensively about the risks of excessive fish intake and taking inappropriate dosages of fish oil in my book, The End of Heart Disease (pp 120 -126, published 2016). 

We still have to question these studies because other studies have shown the opposite. A meta-analysis reviewing all the studies evaluating this question showed that even though some studies show benefit and some studies show harm, it was so random that they could not find such a relationship between DHA, fish oil and prostate cancer.⁷  If DHA and prostate cancer have any association, it is small and insignificant.  However, regardless of whether high-dose fish oils or high fish intake increases prostate cancer or not,⁸ it is not a reason to avoid a small amount of DHA to prevent a fatty acid deficiency and protect against dementia. Especially in those eating a healthy (cancer-protective) plant-based diet.

Fish oil capsules supply about 1000 mg of oil per capsule, (with about half of that EPA and DHA) with many people taking multiple capsules a day. Algae-based DHA-EPA is typically given in the 200 – 250 mg dose, not as a pharmacologic intervention to lower triglycerides or as an anti-inflammatory, but merely to prevent deficiency.

High-dose fish oil is not only suspected to increase risk of prostate cancer, but also the DART 2 study showed that those with heart disease had a 26 percent of increased risk of cardiac death and increased risk of sudden cardiac death in the group that used supplements containing 3 grams/day of fish oil.⁹

These excessive doses can cause problems, as acknowledged by the Institute of Medicine: “high doses of DHA and/or EPA (900 mg/day of EPA plus 600 mg/day DHA or more for several weeks) might reduce immune function due to suppression of inflammatory responses.” The negative outcomes or lack of cardiovascular benefits from fish oil capsules¹⁰ demonstrate that fish oil has no benefit in populations already eating fish, and cannot mitigate the high risk of Standard American Diet (SAD) eating.  

DHA Adequacy

Public health authorities and mainstream nutritional researchers give opinions on supplements based on the general results shown in such large populations studies that generally show no benefits to taking fish oils in populations that regularly eat fish and other animal products. Stating that blood tests are not needed or useful may be true when discussing omnivores and fish-consuming populations, but not when considering vegans, whose blood levels of DHA and EPA are more likely to be low and can even be very, very, low.  I have had some patients whose DHA levels were undetectable.

The fact also remains that DHA and EPA are essential components of brain cell membranes, with roles in membrane structure and function, cell signaling, neuron survival, brain development and repair, and production of anti-inflammatory lipid mediators.^{11, 12}

These fatty acids are considered “conditionally essential.” Because conversion of the essential fatty acid ALA to EPA and then to DHA is limited, consuming pre-formed DHA and EPA may be necessary to have adequate stores of these important fatty acids, according to the Institute of Medicine, which states, “consuming EPA and DHA directly from foods and/or dietary supplements is the only practical way to increase levels of these fatty acids in the body.”

My goal in recommending supplementation with a conservative dose is to ensure people have enough even if their conversion rate is somewhat low. The goal is not to treat a disease; it is not magic, it just assures nutritional adequacy.

Although DHA and EPA are considered conditionally essential, there is not yet an official recommended intake level or definition of deficiency based on blood levels of these fats. However, the omega-3 index, a measurement of the percent DHA + EPA to total fatty acids in red blood cell membranes, is a useful indicator. Estimates based on large population studies on heart disease risk have established that a high risk of heart disease is associated with an omega-3 index less than 4 percent and low risk of heart disease when the percent of DHA + EPA to fatty acids is greater than 8 percent. These levels can be used as surrogates for insufficiency and sufficiency.¹³  I doubt a level of 8 is necessary for excellent health, but one thing we know for sure is that levels under 4 are dangerous and associated with brain shrinkage. 

A study supported by the Nutritional Research Foundation, in attempt to discover how common DHA deficiency was in vegans, analyzed diets and omega-3 blood tests on 166 vegans who were not supplementing with EPA and DHA, finding an omega-3 index of <4% in 64 percent of vegans and the index <3% in in 27 percent of vegans; the majority were in the range considered insufficient.¹⁴ These omega-3 index levels are consistent with those that have been associated with low brain volume in the elderly.¹⁵ The findings agreed with previous studies showing low DHA and EPA levels in vegetarians and vegans compared to omnivores.¹⁶

Average ALA intake by vegans in this study was double the adequate intake set by the Institute of Medicine (3.4 grams/day), and higher ALA intake was not correlated with higher omega-3 index, suggesting that genetically determined conversion efficiency from ALA to DHA and EPA is a more important determinant of DHA and EPA blood levels than ALA intake.¹⁴ A previous study reported similar findings.¹⁷ 

Generalized statements about the value of DHA/EPA supplements have no application when considering vegans. Since the Blue Zones are generally not vegan, they cannot be relied on to determine vegans’ nutrient intake and needs. 

So what do nuts and seeds have to do with omega-3 fatty acid adequacy?

One thing we know for sure—eating nuts and seeds extends lifespan and eating none or only very small amounts (under a half ounce a day) is a risk factor for all-cause mortality. The link between eating nuts and enhanced lifespan is one of the strongest supported findings in the field of nutritional science in the last two decades.¹⁸

In other words, you can deny that eating more meat is bad or you can try to deny that eating more nuts is good, but the evidence from scores of studies that have looked at this with large populations over many decades, all corroborate each other that eating nuts and seeds has a very powerful effect at reducing cardiac death and especially sudden cardiac death (by arrhythmia).  The Physicians’ Health Study even used autopsy data to confirm sudden cardiac death to control for other causes of unwitnessed death and documented reduction of fatal cardiac arrythmias in those with heart disease with greater nut/seed intake.¹⁹

Some have argued that the nut industry funding for such studies invalidates this evidence, but that is easily shown to be false since both types of long-term studies, those with nut-industry funding and those without, showed the same results.^{3, 20-32}

It is also clear that  the remarkable benefits of nuts and seeds has been shown not to be from the effect of replacing meat or other foods, as the data from all the Adventist studies, demonstrated that increased cardiac death from low intake of nuts and seeds was consistent among all demographics, including vegans, vegetarians, and flexitarians. In fact, the association with a lack of nuts and cardiac death became stronger after controlling for lifestyle, diet, including meat intake.³³  The Adventist Health Studies are so valuable because over 30 percent of participants are vegan or vegetarian and many of the non-vegans were flexitarians, utilizing only small amounts of animal products.

Only a document containing extensive references, so people can evaluate the accurate representation of the facts and supportive evidence, should be used to evaluate this issue. Reviewing such studies demonstrates remarkable consistency and clarity.

The point here is that we should not be afraid to eat nuts and seeds even if they are high in omega-6 fats, and we should also eat some omega-3-rich flax and/or chia seeds and walnuts daily too.  Excluding nuts and seeds, or greatly restricting them, is not lifespan-promoting whether one has heart disease or not. I have had thousands of patients and readers of my books, with heart disease, follow my protocol with spectacular results. 

The strategy to attempt to obtain DHA adequacy with severe nut/seed/ fat exclusion and consuming grains and a bit of flax seeds, but no other fats, may or may not be effective to increase the percentage of DHA production by reducing competition for the conversion enzymes. But this method of trying to obtain DHA adequacy may be simultaneously lowering life expectancy and increasing all-cause mortality risk as suggested by the Adventist Health Studies and many other corroborating studies showing increased deaths in the lower quintiles of nut/seed intake.  Plus, these nutritional gymnastics that necessitate the avoidance of most nuts and seeds to raise DHA production do not guarantee DHA adequacy. The aforementioned study on 166 vegans found that greater consumption of ALA and reduced omega-6 from oils and nuts did not correlate with a better omega-3 index.¹⁴ Many people, due to genetic variation in conversion enzyme activity, may still find themselves deficient in DHA when trying to use a nut-avoiding protocol, but even worse, they could find themselves with irreversible neurologic problems in later life.

Note that some nutritional gurus recommend high dose of DHA/EPA for heart disease patients and some recommend none. I take a conservative approach; I am recommending a relatively low dose, a dose not associated with any risks, to prevent against deficiency. I am also recommending that this dose be monitored by blood work when possible to assure the most accurate and beneficial results. Seeing what your blood levels are also makes it possible for you to avoid supplementation when you don’t need it or use more when you do. We are all not genetic clones of each other and modifying recommendations to meet individual needs is a feature of my general guidelines. 

DHA and Dementia

As of 2009, there were at least a dozen epidemiological studies that associate reduced blood levels of omega-3 fatty acids or omega-3 or fish intake with increased risk for age-related cognitive decline or dementia.³⁴ In 2015, a dose-response meta-analysis of dietary DHA found that a 0.1 g/day increase in DHA intake was associated with a 14 percent lower risk of dementia and a 37 percent lower risk of Alzheimer’s Disease.³⁵ DHA is broadly neuroprotective via multiple mechanisms, including limiting the production and accumulation of amyloid beta peptide toxin that is widely believed to drive the disease.^{12, 36} 

That does not mean that giving a DHA supplement to someone with established cognitive impairment or to the elderly after a lifetime of deficiency will prevent or reverse established brain shrinkage or memory loss.  Studies show that giving supplements to those who already have memory loss or dementia does not work.³⁷ This reinforces how important early prevention is and the lack of effectiveness of supplementing after brain shrinkage has occurred should not be used to confuse people into thinking that DHA adequacy is not important. 

For example in the Framingham Heart Study, the top quartile of plasma DHA level was associated with a significant 47 percent reduction in the risk of developing all-cause dementia.³⁸ This epidemiologic study was further confirmed with a case-controlled cohort study called the Rancho Bernardo Study that tracked dietary DHA and plasma DHA to confirm consistency and they found dietary DHA in the highest third was associated with a 73 percent reduced odds of all-cause dementia and plasma DHA in the highest third had a 65 percent reduced odds of all-cause dementia.³⁹

The main points not to forget:

1. Severe deficiencies of DHA are potentially dangerous and associated with brain shrinkage in older adults.^{15, 40, 41} 
2. Vegans can have severe deficiencies of DHA based on dietary factors, but also genetic differences in DHA that we can fabricate from ALA.
3. You cannot guarantee you are safe from later-life neurological problems on a vegan diet, unless you either check blood work or take a supplement.  To do otherwise is a foolish gamble. 
4. Low-dose DHA-EPA has been shown to raise omega-3 index to normal in those that are insufficient,¹⁴ and there is zero evidence that such a low dose of DHA can increase risk of any disease, including prostate cancer. In fact, being DHA deficient would likely increase the risk of colorectal cancers and breast cancers.^{42, 43}   

The thought that the small, but protective, dose of DHA recommended would increase risk of prostate cancer is not merely far-fetched, but ridiculous. 

The people I have seen with depression, dementia and Parkinson’s include close friends and family, and even important well-known leaders in the vegan community. I am passionate about this not happening anymore to people following a plant-based dietary portfolio, especially because that is a diet I advocate.  

DHA and Parkinson’s Disease

Parkinson’s Disease is a common neurologic disease believed to be caused by deterioration of the brain cells that produce dopamine. The link between DHA deficiency and Parkinson’s is not established in the scientific literature, but I have observed a disproportionate number of very healthy-eating vegans and near vegans (and Natural Hygienists) who have developed Parkinson’s. This suspicion that DHA deficiency may increases one’s risk of Parkinson’s is supported by animal models which show that a deficiency of DHA increases sensitivity to the chemical toxins linked to Parkinson’s Disease. Mice fed a Parkinson-inducing toxin (MPTP) became resistant to the chemical when DHA adequacy was established, while control mice (the mice with no DHA given) lost their dopamine-producing cells. DHA protects neurons against the cytotoxicity of chemicals shown to damage dopaminergic cells. The DHA derivative neuroprotectin D1 protects the brain against oxidized proteins.⁴⁴

This is particularly relevant as well-known Natural Hygiene leaders and leaders of healthy eating communities such as Keki Sidhwa and Herbert Shelton died from Parkinson’s Disease. These were my mentors and close friends and I thought they would live healthfully to 100, but instead they suffered with Parkinson’s. I have also seen this happen with some of my otherwise super-healthy eating vegan and near-vegan patients. These people were shocked to have this problem when eating so healthfully for most of their lives and certainly, this was alarming to me. When I checked the blood level of DHA in some of them I found shockingly low levels.

This fear of mine and precaution I take so my followers do not get Parkinson’s Disease may be an important discovery. Certainly, I am not going to risk this happening again in myself, my friends, family and clients following my advice. 

The Conservative Use of Supplements

The DHA/EPA supplement and the other supplements I designed are an important part of my teachings and lifespan-enhancing advice, enabling people to optimize those nutrients of marginal or low presence in their diet and just as importantly avoid unfavorable supplement ingredients and excesses that can cause harm. My protocols assure nutritional excellence while consuming a vegan or near vegan diet, which may not be nutritionally optimal for all people. My providing supplements – as part of my Nutritarian Diet that aims to do much better than the Blue Zones – assures me that people get adequate, but not excessive amounts of DHA, zinc, iodine, D, K2 and B12. This is an important part of this protocol to have a high quality of life after the age of 90.  The supportive data to take these supplements when you are vegan or near vegan is overwhelming, but not a part of this paper.

Since I also teach that conventional supplements contain folic acid, vitamin A and other harmful ingredients, the supplements I have designed makes it convenient for people to follow my general recommendations without consuming unfavorable ingredients. Fish oil can contain microplastics, as can sardines and other natural sources of omega-3.  If someone has a different nutritional viewpoint and are so certain they are better off without supplements, nobody is forcing them to spend their money needlessly; they are free to hold any viewpoint they choose and follow their own path. I however, cannot advise taking those risks and I am not going to impair the health of my family, friends and clients to abide by some mandate that doctors should not be selling supplements, especially while many doctors make a living prescribing needless drugs, creating the need for endless appointments, invasive and needless procedures and surgeries; and while most conventionally available multivitamin supplements inflict harm. I am doing what I think is right and will be most helpful to my followers.

When a person has insufficient evidence or misrepresents the evidence to promote their preferred viewpoint or argument, or when they can’t argue with science, logic and experience, they try tactics to destroy the credibility and integrity of their opposition or of the research. I have become the recipient of such personal attacks attempting to discredit my message.  My message is unique, it has lots of opposition. I am one of the few living physicians who has had a primary care practice for decades caring for a predominantly plant-based community with many thousands of patients. By trying to discredit me, they can ignore the experience of a clinician who has observed people damaged in some way by low-fat vegan extremism. Some may argue from a theory—I argue from real patient experience with many thousands of patients. 

The only way to argue against my having observed healthy-eating vegans with dementia due to severe DHA deficiency is to say I am lying, and attempt to convince people that what I said I experienced had not really happened.  They claim I am fabricating this experience of seeing healthy eating vegans with dementia in later life just to sell DHA supplements.  Note that the only argument to stand on for the support of a vegan diet that excludes nuts and seeds and DHA is claiming the hundreds of the most respected research scientists in the world are in collusion with the nut industry to fake the studies showing cardiac risk from nut exclusion and low-fat diets, and then claiming that I am also lying about non-supplementing elderly vegans developing neurologic problems. 

There are various brands of algae-based DHA available. A consumer can evaluate what is available and consider price, features and quality to meet their needs. Some are more reasonably priced compared to mine that is a refrigerated product packed in glass. 

Lastly, the internet and our free marketplace can be a confusing place at times.

There are those who have used my likeness, name, writings and even excerpted video vignettes of me speaking to promote their products, juicers, infomercials, or multi-level marketing products, and placed my work or derivatives of it on their website without my consent or awareness. Please be wary; my staff has been effective in having some of these taken down, though apparently there are some we don’t find. We have already had to pursue legal action to stop the use of clips of me and statements attributed to me in a television infomercial that I did not agree to participate in. Remember, modern technology can fabricate “evidence” as well as post internet stories that have been faked. 

As Albert Einstein once said, “Don’t trust everything you hear on the internet” 😊