Dr. Gregors new video on DHA for Vegans

[Mr. 95/5]

https://www.youtube.com/watch?v=h4LvCZ0KnKc

Basically says Vegans should supplement with DHA. Does this change things for any of you? I think I'll be adding a little algae oil to my morning smoothies myself...

[EquALLity]

^Algae oil? That sounds pretty gross.

Maybe I should supplement DHA though.

[brimstoneSalad]

Just getting enough ALA (around 3g), and limiting Omega-6, is fine for the vast majority of people. I only believe that the elderly, pregnant, and young children should supplement directly with DHA. I don't think there's good evidence that it's necessary for adults (although fine as a safety net if you want to).

But here's another perspective (one I disagree with, because I think the risks are both trivial and overblown, and based on poor evidence):

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

Summary of Omega-3 Benefits and Concerns

What we know about ALA is summarized in Table 11.

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.

If you are getting the recommended ALA and DHA, EPA should not be a problem. Fish contain about twice as much DHA as EPA (27), so it's not unusual to get more DHA than EPA in the diet. But it is okay to get a supplement with EPA and DHA in it. If you get a DHA supplement with EPA in it, choose one with at least 200 mg of DHA per serving; I have no recommendations for how much EPA it should contain.

I agree with his concerns on cooked ALA sources. ALA should ideally be uncooked or cooked at low temperatures. Use canola oil, but avoid high heat and ideally use it cold. Eat fresh walnuts, flax seeds, etc.

Keep in mind that even if (a big if) high ALA consumption from uncooked plant sources increases the risk of cataracts, they are easily corrected with a very simple surgery (outpatient).

http://www.allaboutvision.com/conditions/cataract-surgery.htm

Thankfully, modern cataract surgery is one of the safest and most effective surgical procedures performed today.

More than 3 million cataract surgeries are performed in the United States every year, with the vast majority of these procedures produce excellent visual outcomes.

The procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility.
[...]
An uncomplicated cataract surgery typically lasts only about 15 minutes. But expect to be at the surgical center for 90 minutes or longer, because extra time is needed to prepare you for surgery (dilating your pupil; administering preoperative medication) and for a brief post-operative evaluation and instructions about your cataract surgery recovery before you leave.

You must have someone drive you home after cataract surgery; do not attempt to drive until you have visited your eye doctor the day after surgery and he or she tests your vision and confirms that you are safe to drive.

It's slightly more complicated than Lasik. The condition itself is in no way life threatening, and is very common and easily fixed.

[Mr. 95/5]

Just getting enough ALA (around 3g), and limiting Omega-6, is fine for the vast majority of people. I only believe that the elderly, pregnant, and young children should supplement directly with DHA. I don't think there's good evidence that it's necessary for adults (although fine as a safety net if you want to).

But here's another perspective (one I disagree with, because I think the risks are both trivial and overblown, and based on poor evidence):

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

Summary of Omega-3 Benefits and Concerns

What we know about ALA is summarized in Table 11.

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.

If you are getting the recommended ALA and DHA, EPA should not be a problem. Fish contain about twice as much DHA as EPA (27), so it's not unusual to get more DHA than EPA in the diet. But it is okay to get a supplement with EPA and DHA in it. If you get a DHA supplement with EPA in it, choose one with at least 200 mg of DHA per serving; I have no recommendations for how much EPA it should contain.

I agree with his concerns on cooked ALA sources. ALA should ideally be uncooked or cooked at low temperatures. Use canola oil, but avoid high heat and ideally use it cold. Eat fresh walnuts, flax seeds, etc.

Keep in mind that even if (a big if) high ALA consumption from uncooked plant sources increases the risk of cataracts, they are easily corrected with a very simple surgery (outpatient).

http://www.allaboutvision.com/conditions/cataract-surgery.htm

Thankfully, modern cataract surgery is one of the safest and most effective surgical procedures performed today.

More than 3 million cataract surgeries are performed in the United States every year, with the vast majority of these procedures produce excellent visual outcomes.

The procedure typically is performed on an outpatient basis and does not require an overnight stay in a hospital or other care facility.
[...]
An uncomplicated cataract surgery typically lasts only about 15 minutes. But expect to be at the surgical center for 90 minutes or longer, because extra time is needed to prepare you for surgery (dilating your pupil; administering preoperative medication) and for a brief post-operative evaluation and instructions about your cataract surgery recovery before you leave.

You must have someone drive you home after cataract surgery; do not attempt to drive until you have visited your eye doctor the day after surgery and he or she tests your vision and confirms that you are safe to drive.

It's slightly more complicated than Lasik. The condition itself is in no way life threatening, and is very common and easily fixed.

Are you a doctor by any chance?

[brimstoneSalad]

Are you a doctor by any chance?

I might be, or I might be a farmer or a plumber.
It's kind of irrelevant, since doctors (like Doctor Greger) are not inherently experts in nutrition. A lot of what he says is right, because he does his research, but some of what he says is also wrong, because he's not immune to cherry picking and personal bias. The peer reviewed studies from credible sources are what's relevant.

The only qualification that's meaningful in itself as a sign of credibility in respect to human diet and nutrition is being a registered dietitian. As Jack Norris is, which is why I posted his advice as part of my response. I just think he's overly concerned with cataracts.

I understand that you have a bias in favor of the need for vegans to get DHA/EPA from dietary sources, because that's part of your brand in justifying the need for oysters. I don't disagree with you on moral grounds that eating oysters is fine, I just don't think your beliefs about their health benefits are justified by the evidence.
There's no need to try to undermine my credibility here; just provide sources and arguments of your own if you disagree. As far as I know, you've still failed to respond to my last reply to you in another thread discussing the health benefits and risks of oysters. That's fine, and it's fine to share this link, but if your endeavor here is to simultaneously ignore my arguments while attacking my credibility instead (by asking something irrelevant like "are you a doctor") to perpetuate your assertions because you can not or will not form your own argument, that's not fine.

[brimstoneSalad]

Here's an article my Ginny Messina on a similar subject.

http://www.v-lish.com/ask-the-dietician-do-we-need-to-eat-fish/
Here's a clip:

The bigger issue is that fish provides the long chain omega-3 fatty acids DHA and EPA. These are found in very few other foods. Our body can convert another fatty acid, called ALA, into these long chain fats, though. ALA is found in plant foods like walnuts (as in Scampi Pasta with Asparagus and Walnuts), canola oil and flaxseed meal. So technically, if we eat enough ALA, we can make DHA and EPA. The truth is that conversion is not especially efficient. So people who don’t eat fish tend to have lower blood levels of DHA and EPA.
But does it matter? That’s the big question. DHA and EPA may help protect against chronic disease but the research on this if very conflicting. And, even if they offer some protection, it’s not clear that people who are already eating a healthy vegan diet need that protection.

You can supplement EPA and even DHA if you want. It's probably harmless to you (less harmless to your wallet).
It's just not clear that it has a benefit. Definitely recommended if you're pregnant/breastfeeding, since you want to be safe and you may not convert enough for baby. And probably good if you're a young quickly growing child or a senior.
Not as likely to be useful to adults, and since you can just consume more ALA to get the same benefits (arguably with a slightly increased risk of developing cataracts, although I disagree with that), I see no reason to inconvenience anybody by recommending it.

[Mr. 95/5]

Are you a doctor by any chance?

I might be, or I might be a farmer or a plumber.
It's kind of irrelevant, since doctors (like Doctor Greger) are not inherently experts in nutrition. A lot of what he says is right, because he does his research, but some of what he says is also wrong, because he's not immune to cherry picking and personal bias. The peer reviewed studies from credible sources are what's relevant.

The only qualification that's meaningful in itself as a sign of credibility in respect to human diet and nutrition is being a registered dietitian. As Jack Norris is, which is why I posted his advice as part of my response. I just think he's overly concerned with cataracts.

I understand that you have a bias in favor of the need for vegans to get DHA/EPA from dietary sources, because that's part of your brand in justifying the need for oysters. I don't disagree with you on moral grounds that eating oysters is fine, I just don't think your beliefs about their health benefits are justified by the evidence.
There's no need to try to undermine my credibility here; just provide sources and arguments of your own if you disagree. As far as I know, you've still failed to respond to my last reply to you in another thread discussing the health benefits and risks of oysters. That's fine, and it's fine to share this link, but if your endeavor here is to simultaneously ignore my arguments while attacking my credibility instead (by asking something irrelevant like "are you a doctor") to perpetuate your assertions because you can not or will not form your own argument, that's not fine.

Firstly, my comment wasn't meant to undermine you, I was legitimately curious. You have a tone of authority in your posts and thought perhaps you were.

Did you watch the video? It's fairly conclusive that adding 250mg of DHA of algae oil a day for vegans is important if you don't want to suffer from accelerated brain loss. It really isn't all that much, and it's easy to add, so I don't see any reason not too. Non-vegans would benefit from it to, since it has the benefits of cod liver oil in that regard without the metal contamination.

My "bias" is nothing more than a desire to be healthy? I am first and foremost an ethical vegan, but now that I'm living this lifestyle I aim to be as healthy a vegan as I can as I believe that sets a great example to others to join suit. Real bias would be if I were connected to either the oyster/mussels industry or the algae industry so saying I have bias is simply incorrect. You say my concern isn't justified by the evidence, but that tells me that you didn't watch the video or have followed Dr. Gregors research on the subject since the evidence was presented in the first post. He's produced about a half a dozen videos on the subject and he's only recently come around to the notion that ALA in flax seeds are not enough for optimum health on a vegan diet. The contrary evidence is rather dated at this point.

I'm not "arguing" with you. Dr. Gregors video is my argument, every reason for me adding DHA to my daily regiment is contained within that video. Am simply sharing it with other vegans to help them in their pursuit of optimum health.

I'm not a big message board person and really only check this forum when I have something I want to post and that's basically been incredibly infrequent. I'll go back to that other thread now, but I really have no interest in arguing, am simply presenting ideas. If you disagree so be it, but I have little interest in an online debate (which is why I'm not a big message board person).

[brimstoneSalad]

Did you watch the video? It's fairly conclusive that adding 250mg of DHA of algae oil a day for vegans is important if you don't want to suffer from accelerated brain loss.

It isn't, though. Those studies are done on people starting in their late middle ages. I said that the elderly/seniors should supplement, and that's in line with consensus, because conversion efficiency may drop later in life.

Greger is telling everybody to do it, which is probably just silly for 20 - 30 year olds who are eating enough ALA.
He even cited a target number (which is good), but that 1/3rd of vegans (who likely aren't already supplementing) are already at more or less the right number. Most of the other 2/3rds probably just need to eat more ALA.

I understand why Greger is recommending it, because it's probably harmless, and he has no concept of parsimony when it comes to cost or inconvenience.

Better and easier advice is just that vegans should try to reduce Omega 6 fatty acids, and eat more Omega 3. There's no mechanistic reason that wouldn't be adequate, and no comparative analysis that says it isn't. We even know about how much we need to eat.
For pregnant, nursing, young children, and the elderly that recommendation can be to supplement with algae oil.
As you reach 40 or 50 years old, it starts becoming a better idea to supplement DHA. By the time you're 60, it's probably a very good idea.

I don't buy it as a recommendation to all adults, since it's not practical for a lot of people, and they may decide not to go vegan if they think they need to take a large number of supplements to keep their brains from rotting away. There's just not good evidence of that.

https://youtu.be/h4LvCZ0KnKc?t=49

maybe the dementia lead to a dietary defficiency rather than a dietary defficiency leading to dememntia

Or both just correlate with ageing.

https://youtu.be/h4LvCZ0KnKc?t=66

See the chart?
The age at which this divergence is being observed is at earliest 60-65.
Unless you actually believe the straight line plot on that graphic and think that taking DHA makes 20 year olds precognitive.
There's really very little meaningful difference until the mid to late 60s, if any at all.

I accept the difference in seniors, I think there's some credible evidence of that (although I don't think it's necessarily relevant in vegans).
The things is that it may also not be caused by the DHA or lack of directly, but by inflammation and poor circulation to the brain.

The next study he cites is on people over 65:
J K Virtanen, D S Siscovick, R N Lemaitre, W T Longstreth, D Spiegelman, E B Rimm, I B King, D Mozaffarian. Circulating omega-3 polyunsaturated fatty acids and subclinical brain abnormalities on MRI in older adults: the Cardiovascular Health Study. J Am Heart Assoc. 2013 Oct 10;2(5):e000305.

http://www.ncbi.nlm.nih.gov/pubmed/24113325
Check out the abstract

BACKGROUND:
Consumption of tuna or other broiled or baked fish, but not fried fish, is associated with fewer subclinical brain abnormalities on magnetic resonance imaging (MRI). We investigated the association between plasma phospholipid omega-3 polyunsaturated fatty acids (PUFAs), objective biomarkers of exposure, and subclinical brain abnormalities on MRI.
METHODS AND RESULTS:
In the community-based Cardiovascular Health Study, 3660 participants aged ≥ 65 underwent brain MRI in 1992-1994, and 2313 were rescanned 5 years later. MRIs were centrally read by neuroradiologists in a standardized, blinded manner. Participants with recognized transient ischemic attacks or stroke were excluded. Phospholipid PUFAs were measured in stored plasma collected in 1992-1993 and related to cross-sectional and longitudinal MRI findings. After multivariable adjustment, the odds ratio for having a prevalent subclinical infarct was 0.60 (95% CI, 0.44 to 0.82; P for trend = 0.001) in the highest versus lowest long-chain omega-3 PUFA quartile. Higher long-chain omega-3 PUFA content was also associated with better white matter grade, but not with sulcal or ventricular grades, markers of brain atrophy, or with incident subclinical infarcts. The phospholipid intermediate-chain omega-3 PUFA alpha-linolenic acid was associated only with modestly better sulcal and ventricular grades. However, this finding was not supported in the analyses with alpha-linolenic acid intake.
CONCLUSIONS:
Among older adults, higher phospholipid long-chain omega-3 PUFA content was associated with lower prevalence of subclinical infarcts and better white matter grade on MRI. Our results support the beneficial effects of fish consumption, the major source of long-chain omega-3 PUFAs, on brain health in later life. The role of plant-derived alpha-linolenic acid in brain health requires further investigation.

As far as I can tell, this could be an entirely cardiovascular effect. What we're dealing with is basically subclinical strokes, or silent strokes (they excluded subjects with more serious strokes, I suppose to measure more subtle effects).
This was not a study on vegans or other low risk groups.
Of course consumption of DHA is much more protective in people otherwise eating a higher risk diet.

Regarding size of brain, or the shrinking he's talking about, that's normal in ageing (the white matter of the brain may not even be finished developing into middle age), and really just serves as fear mongering. I don't think that was an appropriate reference or relevant to the issue.

I couldn't even find the quote he cites in this study.
http://jn.nutrition.org/content/134/1/183.long
However, it has long been known that conversion reduces with age.

The next study:
Z S Tan, W S Harris, A S Beiser, R Au, J J Himali, S Debette, A Pikula, C Decarli, P A Wolf, R S Vasan, S J Robins, S Seshadri. Red blood cell ω-3 fatty acid levels and markers of accelerated brain aging. Neurology. 2012 Feb 28;78(9):658-64.

Abstract
OBJECTIVE:
Higher dietary intake and circulating levels of docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) have been related to a reduced risk for dementia, but the pathways underlying this association remain unclear. We examined the cross-sectional relation of red blood cell (RBC) fatty acid levels to subclinical imaging and cognitive markers of dementia risk in a middle-aged to elderly community-based cohort.

Here's the whole thing if you want:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3286229/

Pretty much the same thing. They're looking at subclinical markers. Again, this could be largely or maybe entirely cardiovascular.

I'm interested in specific mechanistic factors here, and he's not giving any.

It's a lot of speculation in older subjects without ALA or as far as I can tell adequate cardiovascular controls. I'd be more impressed with a comparative intervention study using a vegan diet high in ALA pitted against the DHA. I don't think we'll see that in a younger population, though (under 50) because there's just not really anything to study there.

It really isn't all that much, and it's easy to add, so I don't see any reason not too.

Cost and inconvenience, and there being no apparent reason for an adult under 50 eating a source of ALA to do it.
These supplements are not available everywhere, they kind of need to be refrigerated, and they aren't that cheap. You also have to remember to take it, etc.

Non-vegans would benefit from it to, since it has the benefits of cod liver oil in that regard without the metal contamination.

Non-vegans probably benefit a lot more, because they have greater cardiovascular risk factors.
I'm not convinced that relatively young or middle aged vegans need to worry about it.

My "bias" is nothing more than a desire to be healthy? I am first and foremost an ethical vegan, but now that I'm living this lifestyle I aim to be as healthy a vegan as I can as I believe that sets a great example to others to join suit.

I think making it easy and not telling people to take supplements when there's no clear evidence of benefit is more likely to encourage others.
Most people aren't after optimal health. People smoke, and they knowingly eat junk food (with no doubt in their minds that it's not healthy).
I think we just need to make sure that vegans aren't less healthy than other people, and I don't think this is necessary to do this.

Greger even said that our nutrient status for DHA is about the same as people eating the standard American diet. That puts us ahead, because we have fewer other risk factors. We just need to eat a little ALA. Choosing better oils, for example.

Real bias would be if I were connected to either the oyster/mussels industry or the algae industry so saying I have bias is simply incorrect.

I don't think a financial incentive is required for a bias, no. People just want to be right; ego is enough to bias anybody, you or I or anybody else. As human beings, we don't like to have been wrong.

I'm just trying to follow the evidence. Right now the requirement to take DHA instead of just getting enough ALA doesn't seem to be the consensus among vegan dietitians, except for the cases I mentioned where it's recommended as a precaution.

It just doesn't have the status of evidence as does B-12 or vitamin D.

You say my concern isn't justified by the evidence, but that tells me that you didn't watch the video or have followed Dr. Gregors research on the subject since the evidence was presented in the first post.

I just broke down his argument, so hopefully you can understand why I'm unconvinced.
Ginny Messina said about the same thing in the quote I gave you in the last post.

He's produced about a half a dozen videos on the subject and he's only recently come around to the notion that ALA in flax seeds are not enough for optimum health on a vegan diet. The contrary evidence is rather dated at this point.

Greger has no notion of parsimony. He regularly recommends very tedious and expensive practices which have questionable benefit at best. If we parrot his advice on most issues, I think we will find that very few people are interested in that kind of veganism.

[Mr. 95/5]

I understand your main point, that the idea of having to supplement with DHA could deter new vegans due to the inconvenience factor. But it is important to keep in mind that many non-vegans desiring optimum health supplement with cod liver oil. Perhaps this information should be presented as such, that we are doing no different than those people just with algae, but for vegans like myself who are trying to be as healthy as possible for the long term, this is valuable information. If you wish to not take the advice, that is certainly your prerogative, but I don't think it's worth the risk.

[brimstoneSalad]

But it is important to keep in mind that many non-vegans desiring optimum health supplement with cod liver oil.

That's called medicating. Doctors actually prescribe these things. Those non-vegans should probably be taking algae based supplements, since they have a lower risk of contamination.
And many also 'supplement'/medicate with statins. That's because they have to, due to higher cardiovascular risk.
They don't do it (DHA) for their brains, but for the evidence based effect on lowering cardiovascular risk.
Vegans already have lower cardiovascular risk, assuming they are avoiding saturated fats and getting their Omega 3s.

Vegans need to supplement B-12, while non-vegans need more to supplement DHA/EPA, asprin, statins, metamucil, antioxidants, etc.
Non-vegans sometimes need B-12, particularly when they're older, and it can't hurt.
Vegans sometimes need DHA, particularly when they're older, and it can't hurt.

But it's important to understand, at least for vegan advocacy, that it's not a requirement, there's not really any basis in the evidence for a need during young adulthood, and that saying things like:

It's fairly conclusive that adding 250mg of DHA of algae oil a day for vegans is important if you don't want to suffer from accelerated brain loss.

...Is terrifying and will inevitably frighten some people away from veganism. And for no reason.

You could just as easily and inaccurately say

It is conclusive that all vegans suffer from accelerated brain loss unless they take special expensive and often hard to find supplements made in a factory using hexane chemicals from slimy green algae every single day. So don't go vegan unless you're ready to stay on top of it or your brain will wither away rapidly. Easier and safer just to not go vegan, right?

That's how I read what you said, and how carnists will read it to justify their actions.

No, it's not important. No, there's no evidence of accelerated brain loss without it. And even without focusing on vegans who take care to eat Omega 3s, our levels are about the same as non-vegans who don't eat a lot of certain kinds of fish.

Perhaps this information should be presented as such, that we are doing no different than those people just with algae

That would be a better way to present it. Don't focus on vegans. Don't overstate how conclusive it is (it's controversial and far from it). And don't use scary phrases like "accelerated brain loss", because there's no evidence that's what going on.

Just say you think that all people should take DHA for the brain, which the optimal source is algae oil, 250 mg a day (whether you're vegan or not), and that it's even more important for non-vegans because they are at higher risk of heart disease and DHA reduces heart disease risk too.

but for vegans like myself who are trying to be as healthy as possible for the long term, this is valuable information. If you wish to not take the advice, that is certainly your prerogative, but I don't think it's worth the risk.

The risk is unquantified, though, so you don't know if it's worth the risk or not. It could be one in a million, or one in a billion.

What if I said "Here, wear this protective cross to protect you from the devil" What are the chances the devil is real? What are the chances this thing works at all without evidence? Very small, at best. But you wear it anyway because "what's the harm?".
The next day you add another protective amulet, and another. One from every religion and superstition in the world. Then your neck breaks under the weight of them all.

Applying preventative or protective measures without evidence or reason is not in itself without cost and risk. You could very well choke and die trying to swallow one of those pills, even. Low risk? Sure, but not really no risk. And if you don't know the risk it's protecting you from, you may be making yourself worse off. And that's not even mentioning the dubious quality of supplement and all of the risks that come from lack of government regulation of the industry -- you could be swallowing a gelatin capsule filled with lard instead of vegan capsule filled with legitimate algae oil -- what risks do those entail?