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Do Flaxseeds Offer Sufficient Omega-3’s for Our Heart?

According to two of perhaps the most credible nutrition authorities, the World Health Organization and the European Food Safety Authority, we should get at least half of a percent of our calories from the essential omega-3 fat ALA. That’s easy: Just have about one tablespoon a day of chia seeds or ground flaxseeds and you’re all set.

Our body can then take the short-chain ALA from our diet and elongate it into the long-chain omega-3s, EPA and DHA. The question, however, has long been whether our bodies can make enough EPA and DHA for optimal health. How would one determine that? Take fiber, for example. “A convincing body of literature showed an increased [heart disease] risk when diets were low in fiber,” so the Institute of Medicine came up with a recommendation for about 30 grams a day, which is an intake observed to protect against coronary heart disease and to reduce constipation. “Thus, just as [cardiovascular disease] was used to help establish an [adequate intake] for dietary fiber,” it was also used as a way to develop a recommendation for EPA and DHA, as I discuss in my video Should We Take EPA and DHA Omega-3 for Our Heart?.

With reviews published as late as 2009 suggesting fish oil capsules may help with heart disease, nutrition authorities recommended an additional 250 mg per day of preformed EPA and DHA, since, evidently, we were not making enough on our own if taking more helped. So, in addition to the one or two grams of ALA, it was suggested we should take 250 mg of preformed DHA/EPA, which can be gotten from fish or algae.

Fish is a tough one. On one hand, fish has preformed DHA and EPA, but, on the other hand, our oceans have become so polluted that seafood may also contain various pollutants, including dioxins, PCBs, pesticides like DDT, flame-retardant chemicals, and heavy metals, including mercury, lead, and cadmium, all of which can negatively affect human health. Dietary exposure to PCBs, for example, is associated with increased risk of stroke in general and an almost three times higher risk of hemorrhagic stroke. Unless you live next to a toxic waste dump, the major  source of exposure to PCBs is fish consumption. Salmon may be the worst.

This may explain why studies in the United States have shown that just a single serving of fish a week may significantly increase one’s risk of diabetes, emphasizing that even levels of these pollutants once considered safe may “completely counteract the potential benefits of [the omega-3] fatty acids and other nutrients present in fish,” and lead to the type of metabolic disturbances that often precede type 2 diabetes. Now, one could get their daily 250 mg of preformed DHA/EPA from algae oil rather than fish oil. Algae oil is free of toxic contaminants because it is manufactured without pollutant exposure. 

Then, one could get the best of both worlds: the beneficial nutrients without the harmful contaminants. However, it was demonstrated recently that these long-chain omega-3s don’t seem to help with preventing or treating heart disease after all. Since that was the main reason we thought people should get that extra 250 mg of preformed EPA and DHA, why do I still recommend following the guidelines in my Optimum Nutrition Recommendations? Because the recommendations were not just based on heart health, but brain health, as well. See my video Should We Take DHA Supplements to Boost Brain Function?.

Other omega-3 videos include:

If the no-heart-benefit surprised you, check out Is Fish Oil Just Snake Oil?.

Surprised by the link with diabetes and want to learn more? See:

Food Sources of PCB Chemical Pollutants has more on PCBs, and here are additional videos on other pollutants:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:


Michael Greger M.D., FACLM

Michael Greger, M.D. FACLM, is a physician, New York Times bestselling author, and internationally recognized professional speaker on a number of important public health issues. Dr. Greger has lectured at the Conference on World Affairs, the National Institutes of Health, and the International Bird Flu Summit, testified before Congress, appeared on The Dr. Oz Show and The Colbert Report, and was invited as an expert witness in defense of Oprah Winfrey at the infamous "meat defamation" trial.

92 responses to “Do Flaxseeds Offer Sufficient Omega-3’s for Our Heart?

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  1. So I am confused….can we rely on just the flax and chia for the heart and brain-help, as
    suggested for fish oil? I’d rather not take an algae supplement (adverse reactions
    in the past to these). Does relying solely on flax/chia deny vegans the beneficial
    aspects of the long-chain omega 3’s for brain health?

    1. My understanding is that he believes that the evidence indicates that many people can’t convert enough ALA to DHA/EPA to ensure optimum brain health. This is why he recommends contaminant–free DHA/EPA supplements (250 mg per day).

      It used to be possible to buy EPA sourced from yeast but that product has apparently been discontinued so now it’s a choice between algal, fish and krill sourced DHA/EPA supplements.

      1. Hi,
        Thanks for clarifying what Dr. Greger’s position might be here. My comment is mainly to re-iterate that the blog post conclusion paragraph above is kind of ambiguous. After reading this blog, I too am not sure if “relying solely on flax/chia den[ies] vegans the beneficial aspects of the long-chain omega 3’s for [optimal] brain health”.
        I realize that this is the comment of a worried-well person, but if I can be 1% healthier, I’d be happy to add DHA of algal derivation, just not clear if it is needed over and above flax/chia ingestion.


    2. Yes Hazel, that’s what I want to know too re ground flaxseeds for brain health also. As far as I know Dr Esselstyn just recommends the 1 tbsp flax, and Dr Ornish recommends 2 (!) grams of fish oil – so there is some difference of opinin among the plant base docs. I was hoping he would address it here. Algae supplements are not going to happen.. very costly!
      If it has to be something, fish oil it is.. but they increase the risk of bleeding too (in me).
      My doc says eat fish 2 x per week…..

      1. @Barb:

        “Algae supplements are not going to happen.. very costly!”

        I am not sure what you consider “very costly” but they are most expensive that some supplements, yes. But the ones I buy from Amazon ends up being a whopping $0.24 per day. Indeed, $22 for a bottle of 90 sounds like a lot when you are spending it all at once but really, a quarter per day when added to the few other supplements that I take (since I eat a great diet) only includes D, B12, Iodine. That pushed my supplement cost to around $0.35 per day.

        $0.35 per day to help me make sure I get my nutrient needs – cheapest insurance policy ever.

      2. “My doc says eat fish 2 x per week…..”

        Barb, maybe you should listen to your doc in this case. You might try it for a couple of weeks and see how you feel.

      3. Algae supplements caused me similar bleeding issues as fish oil.
        I avoid them both for this reason.

        It’s either make flax seed work, or eat some fish, or do neither (which
        in no way is a horrible thing, in my opinion, if one is eating a healthy
        and well-rounded diet.

      4. Eating OILY fish twice a week is the standard mainstream advice and if those are the only animal foods you consume, then that is entirely consistent with eating a whole food plant-based diet.

    3. You’re not alone. Members of my family are allergic to sunflower oil and it is impossible to find DHA without sunflower oil unless using fish oil.

    1. “What about results of REDUCE-IT study?”

      I would expect that if you already eat a healthy diet that there is no reason for the costly high dose lipid pill.

      Or, if one is already high risk, just change the diet.

      The article seemed to have left some details out but 1) the group studied was already at high risk and 2) I didn’t notice (but it could have been in there) where any sub-group in the test went on a more plant based diet.

      Thus, did the people at risk continue their bad habits and then just add supplementation? Well, added a good thing to a bad diet may have some positive effects and gives the general population what they always want to hear – “Here is a pill that can overcome some of your bad habits.”

      Or, eat a plant based diet and avoid their prescription that likely cost serious money. When in a period as short as a week you can start to have large impacts on health markers like lipids, blood sugar, etc. by simply changing your diet when not just change the diet?

      Did I misunderstand the study? Please correct me, but the comments above is what that article made me think of.

      1. Update –

        I blew threw the study again and do see, my bad for missing this, that they mention ‘diet’ but I don’t see details of the ‘diet’ or if they are simply referring to the ‘diet’ that the test subjects normally ate.

        But, since there is no clear diet comparison test, me thinks that the patients are not eating healthy diets.

        1. Agree. The population in the study were patients with either established CVD or multiple risk factors for CVD. All on statin and other treatments. Not a healthy population, and likely poor diet (though not reported). Cannot generalize the results outside the scope of the study, which the authors also point out.

        2. Just change your diet and everything will be fine Michael. Not always the case. I have an inherited cholesterol problem that improved (it was over 300!) when I went WFPB 5 years ago. But it is still in an unacceptable range, and the triglycerides are high. When I read about how to reduce T’s, I am told to eat more of the kind of diet that I already eat. I follow most of what Dr. G. advises. So Michael,maybe you can tell me what to do. Thanks. PS. I eat healthier than my doctors; they haven’t a clue outside of statins.

          1. If you have genetically high cholesterol that can’t be brought down to safe levels by the standard lifestyle changes – giving up alcohol and tobacco, losing weight, eating a WFPB diet and daily exercisee – then you might nave to bite the bullet and consider drug options.

            I presume that you already take amla daily, and psyllium husk two or three times per day?

  2. Off-topic comment. If off-topics comments cause you apoplexy, don’t read any farther.

    A number of people have previously expressed concerns about weight problems. They may be interested in this ScienceDaily report of a recent study reporting increased weight loss using a new (non-dietary) technique. The technique is apparently also usable in other areas eg for increasing personal physical activity levels.

    “The study showed how after six months people who used the FIT intervention lost an average of 4.11kg, compared with an average of 0.74kg among the MI group.
    After 12 months — six months after the intervention had finished — the FIT group continued to lose weight, with an average of 6.44kg lost compared with 0.67kg in the MI group.”

    There are a number of free resources available for those who want to use this technique on a DIY basis

    1. Tom,

      I watched the FIT Sleep disorder session, which they have online and I think it mirrors the “brain plasticity” sessions I have been walking myself through to change my eating habits.

      Renewing the mind.

      I do a little bit more celebrating and educating as part of my process but they are doing more visualization and that is part of brain plasticity and stroke recovery, so I already have tried to incorporate it.

      Having someone’s sleep session in front of me is positive motivation that I might be able to figure out how to sleep eventually. The woman was saying that she falls asleep after 4 in the morning and that is when I have fallen asleep for over a decade and I thought it was because that is when my caretaking shift ended. Her saying it makes me wonder if there are other reasons and I know that the house gets extremely quiet at 3 in the morning. So quiet that if I try to fall asleep then I just listen to the quiet and I am somehow distracted by it. White noise doesn’t work for me. I listen to that, too. But her session reminded me that listening to loud silence and listening to white noise is an auditory focus problem. Somehow I need to get into a less auditory part of my brain. I don’t know if that makes sense, but that is what I came away with after watching the woman’s session. Now, I just have to look up parts of the brain and find one, which isn’t auditory. Maybe visualizing as what I focus on might keep me out of the listening mode. Not sure, but it is worth a try. It has been decades without sleep.

        1. Thanks, Tom!

          I don’t have internet at home, but I can use Youtube videos just as long as I don’t fall asleep and use up all of my cell phone data minutes.

          When I was younger I had a young man who would like to fall asleep talking with me on the phone for hours and eventually our talks became long distance and he had to be the one who called because if my voice was going to be comforting enough to put him to sleep I needed him to wake back up and hang up eventually.

          1. When I lived in California, I had a brain-machine, which did all the different wavelengths and that did help. I went to a brain gym and did isolation tanks and all sorts of other cool things. It was genuinely relaxing.

            1. I was so spoiled out there. I had someone who came and did massages for $20 for a half hour and I had another person who charged about that for use of a Pilates Reformer and I paid about that to have someone cook all my meals and deliver them once a week and I paid about that to attend play therapy.

          2. Wow Deb, sounds like this guy was a “user.” It’s fine to be enabling/nurturing, and all that, but to give up so much of your own personal time for someone like that is going way overboard IMO. :-(

            Seems to me you should have charged this self-absorbed, selfish dude. Was there something emotionally wrong with him?

              1. LOL!


                He was a young man from a family so poor that he lived out on the street as a young person. His father was an alcoholic who tried to train him to be a psychopath, and his mother was in and out of mental institutions and his siblings were less stable than his parents. Yes, I walked him through when he was trying to “escape” and had rung up a $100,000 in student loans and was unemployed and had maxed out all of his credit cards and had never been able to be in a relationship and now he is a fairly wealthy world traveler who wrote a book, made a movie and wrote a low-level NY Times Best Seller and he is married. We walked through all of that “old school” where people called friends were just there for each other warts and all. I know that most people don’t do that anymore. Now people pay professionals to listen and to care. I grew up when that was what friends did.

                1. That’s…..quite a story!

                  Was the movie ever released, or did it go straight to video? Was his book self-pubbed, or did he find a publisher?

                  I’d love to know this guy’s name, but I’m sure you wouldn’t want to reveal it.

                  1. Not self-published. His was a fairly “B” movie. Might have played select theaters. Not near me. Three or four of his friends made “A” movies, but none of them would be people’s names you would know. The actors and actresses in them would be people you know. Not my friend’s movie. He is not a name in either movies or books. He is someone who had a bucket list and has become excellent at checking everything off. He wrote one sentence in his book about me and wrote a script about me a long, long time ago. He thinks I should write a book but I don’t even know that I could write a book and he had the charisma to make it to the NY Times Bestseller list and Dr. Greger might make that look easy, but it genuinely is a hard thing to accomplish. I have another friend who wrote something brilliant and won awards and was compared to Salinger and I don’t think he made it. Maybe. Not sure. I just know that it is not easy.

                    1. YR,

                      I am not going to give my friend’s name. He is someone precious to me.

                      You cannot possibly know it but he is twice as precious for every very-long-very-needy phone call I received when he was a young man, but he is so healthy now. I believed in him back when he couldn’t hold a job for more than 2 weeks and couldn’t rub 2 nickels together and he just rose up and became exactly what I thought he could be. Maybe even better.

                    2. Awwww, you’re a good lady, Deb! :-) I myself was an easy touch back in the day — for instance, giving people $$ because of hard luck stories, etc. In fact, a few months ago I “lent” $2,000 to somebody, but now have a strong feeling I’ll never get it back. “Neither a borrower nor lender be.” :-(

                      It’s said we all have a book in us; I know I sure do. I took on a lot of biggie challenges this time ’round, but feel I’ve handled them very well. We’re here to learn, to grow….and to remember.

          3. Tom,

            I have decided to listen to it a few hours before bed and see if that helps.

            My work building is less than a half a mile from my home so I can go there for a while.

            Tonight will be Take 1.

            If I am not posting at 3:30 and 4:30 in the morning, I will have not been so wide awake that the silence is deafening.

            1. Laughing, because it is 1 AM and the problem with going down to work to watch videos is that I am working at 1 AM. It was worth a shot.

  3. My wife gets a stomach ache when she eats certain nuts or seeds that includes flaxseeds. She doesn’t have a problem to eat walnuts though, but peanuts are not good for her. Don’t know the cause could be her gallbladder being removed.

    We put flaxseeds in oatmeal. Wondering any suggestion on any alternative way for her to take flaxseeds? What is next best after flaxseeds? Appreciate any input.

    1. the common weed purslane is supposedly the best plant source for omega-threes. It is super common weed and easy to grow in warm months. I grow this kind:

      It takes gettign used too…slimy like okra (but I LOVE okra, so it works for me!) .
      I put in veggie gumbo, stir fries, soups and smoothies.
      YOu couldgrow extrain summer,process in blender and free for winter use in the above recipes.

    2. Hi! You can add them to a smoothie as the blender will break them down for digestion/assimilation or try grinding down in a coffee grinder to a powder and stir into soups, stews, sprinkle over steamed veg – whatever you’re eating, scatter them on just before serving :)

    3. I use my smoothie (can no longer do it every day; alternate with whole grain cereal) as a place to dump stuff I need like chia or flax. Also, I have been interested in a chia pudding which you mix and refrigerate overnight. I know it is made with a nondairy milk, chia, some fruits and don’t know what else. But google it if you are interested in experimenting. Oh, one more thing: I finally found a pure buckwheat pancake mix with no oil, dairy, or sugar or eggs. It’s called Bouchard Family Farms french acadian buckwheat ployes. I make it up for a pancake, add 1 or 2 T. of flaxseed (ground), plus an abundance of those wonderful tiny blueberries from Maine (the pancake mix is also from Maine, buckwheat grown in Fort Kent ME). The mix is hard to find but worth it to order from Amazon. I finally gave up the butter, but I do allow myself 2 T. of pure maple syrup from New England. So there you go, 4 different ways to use chia or flax. I get my flax from Trader Joes, it’s whole and toasted. Then I grind some in an old coffee grinder which I keep in refrigerator so I won’t have to do it every time. Sorry I’ve given you more info than you wanted I know!

      1. Watercress, thank you for some good recipe ideas. Btw, according to a study, you absorb more of the good oils from chia also if you grind them as you do flaxseed.

    4. You could add ground flax seed to banana ‘ice cream’. .

      Slice bananas, put them in the freezer for an hour or two, then put them in the blender (you may need to add a little water) with whatever you fancy – berries, cacao powder, pecans, ground flax seed etc. Then store the ‘ice cream’ in the freezer Unless you want to eat it straight away.

      Chia seeds are also worth considering.

        1. I can’t resist adding my recipe…. I freeze 1.5 peeled bananas in the freezer overnight. The next day, I put a scant half cup pure soy milk in my high speed blender with the bananas and mix together till Dairy Queen consistency. Sometimes I add a tbsp of cacao powder if I’m feeling like chocolate. Then I pulse in some dark sweet frozen cherries and some walnuts. Sort of like Ben & Jerry’s Cherry Garcia…. :D

  4. Flaxseed, ALA, can be filled with chemicals, overwhelming our detoxification pathways. Particularly the second phase. Result, not enough energy and overwhelmed poorly functioning metabolic machinery.
    In a healthy system flaxseed Omega 3 metabolism propduces little DHA and EPA (according to the science I know).
    And then there is the enigma of The Esselstyn Diet. Plants and remove all oils, the system rights itself. I prescribe this to serious cardiac patients.
    Eat a rainbow clean plant based diet. Hack your detoxification pathways. You may need help on how. are leaders, heroes, and a fabulous resource.

    1. Dr, good what do you recommend for vegans. Debate goes on and on while those of us who are vegan may be suffering heart issues or brain issues. If we can’t get enough long chain fatty acids from the conversion of ALA from plaques are Chia, and DHA and EPA supplements are going to damage your brain as someone posted a study of, what are we supposed to do. Or is this ultimately an indictment of a plant based diet?

      1. Dana, I agree this is an important issue. However, I don’t see this as an indictment of plant-based diets. Remember, meat eaters are more susceptible to a whole range of illnesses that WFPB vegans can avoid. Rather, I see this as an indictment of the food available today and our current understanding of the human body. IMHO, I think we have a long way to go.

        I listened to a fascinating radio interview a few years ago. The guest was a doctor of botany or anthropology (something like that). Anyway, she talked about how our ancient ancestors’ diets consisted of a range of plants that are much richer in nutrients than anything offered in grocery stores today — multiple times higher than spinach and broccoli, for example. Unfortunately, we no longer eat these plants. People now consider them weeds.

        I think this deserves further study. Is anyone getting all they need from our factory farming, big agriculture system? I also believe the human body wasn’t designed to eat meat, so I highly doubt the solution to the omega 3 question will be found there.

      2. Hi I’m a RN health support volunteer.
        No, this one 8 week study is not an indictment of a plant based diet. I noticed this was also done with high dose injectable DHA and EPA. Dr. Greger recommends 250mg/day. They used 7mg/kg subcutaneous injections. For 150 pound person, that would be 477mg.
        There is a vast amount of studies which demonstrate the efficacy of plant based diet for preventing cancer, heart disease, diabetes, arthritis, autoimmune disease just to name a few. And a lot studies indicting a high animal protein diet.

        Dr. Greger just answered a question about this in his Sept. youtube life Q&A. Omega 3 supplementation is controversial at this time and there is room for more studies on it. He has chosen to supplement it for himself.

        This is some more information Dr. Greger has:

        Thanks for your great question.

    2. Are you saying that organic whole flax seeds can overwhelm our detoxification
      pathways? Or are you just referring to flax oil and or conventional flax seeds?
      Very interesting if even whole organic flax might contain some natural properties
      that are a bit too much for some people. Hope to hear back from you on this one.

    3. .Are you saying that organic whole flax seeds can overwhelm our detoxification
      pathways? Or are you just referring to flax oil and or conventional flax seeds?
      Very interesting if even whole organic flax might contain some natural properties
      that are a bit too much for some people. Hope to hear back from you on this one.


  5. I’d love to know if increasing the intake of flax seeds to two or three tablespoons per day would compensate for not taking the DHA/EPA supplements. There’s no way I can even get that kind of stuff for a reasonably expensive price here in Brazil.

    1. Flax seeds provide short chain omega fatty acids. Some people don’t convert the short chain to the long chain DHA/EPA. That is why Dr. Greger says to consider taking an Omega 3 supplement and takes one himself. But he just mentioned in his Sept. live youtube q&a session and that is is controversial. I’d check that out if you have a chance.
      Omega 3 supplements may have some advantage, but are not imperative like Vitamin B12 supplementation. The flax seeds are great for you regardless.


    1. With respect Panchito, that was a study done in rats. You can not always apply rat studies to human brains. A big red flag for me as well, is the fact in the methods section they do not say how many rats were in each group. No way of knowing if the groups were sufficiently powered in terms of statistics to really uncover an effect. IT does not look like it has been replicated. It is a theorectical model really at this point, IMO. And judging by the number of citations, not gaining traction in the scientific research community. SO I would not say this is robust science yet.

    2. Reading it, the recommendation was to eat antioxidants when people take them.

      I guess I would have to drink my green tea without soy milk.

      I am watching a show on origami and they are producing proteins which bind with things like the flu. They already can maybe make a designed protein to prevent the flu in mice.

      They said that protein origami is the future of drug development.

      They also had an origami heart stent.

      1. It sounds like the protein functions like enzymes.

        Lock and key.

        Most of these cool things probably won’t be in my lifetime.

        I am wondering how many decades before they let people get the 3-D laser organs.

        1. The PBS Mayo Clinic documentary made me cry. How did we not end up with health care like that?

          It made me want to move to Rochester and find a way to go back in time.

          My friend went there 20 years ago. She loved it.

          Genuinely I might have gone into medicine if I saw a community like that.

          I might cry all night because I saw that.
          How did we not end up with leaders like that?

          1. Maybe I feel the same about WFPB.

            My precious friend was told that she has abnormal cells,suspicious, but they aren’t diagnosing Cancer yet. She has other spots to biopsy and they want to check more internally.

            We talked about WFPB and about changing the doubling time of Cancer.

            I said to her that she could be off her insulin and not have as much back pain in two to four weeks.

            I told her that I don’t need her to make up her mind on the spot. I need her to understand that if she does it that she could solve so many other of her health issues and this could become the best thing which ever happened in her life.

            She is following other people because she doesn’t think she could do it but she has heard the truth and that will percolate up about the time of the other biopsies.

  6. So, we should take the EPA/Dhaka supplement for our brain even though it doesn’t help with heart health. Ok, but you(dr Gregor) fails then to tell us what to do to solve the heart health issue. Just forget about it? Ignore it? I mean, he tells us we can’t get enough long chain fatty acids from flax or chia, but has no suggestion to remedy this?? If he can’t address this, if this is impossible to address on a plant based diet, how can he continue to encourage people to eat plant based for their health. Sure, we won’t be obese, have high blood pressure or get diabetes, but we will die of cardiac arrest.

    1. Dana, I don’t think Dr G said you can’t get enough long chain fatty acids on a Vegan diet. He said the evidence indicates LCFA don’t protect against heart disease.

      So what to do? Eat a WFPB diet which for the vast majority will prevent (and reverse) CVD. Am I missing something? Is cardiac arrest a concern for the WFPB crowd?

      1. At one point I remember dr g did a video on the importance of b12 in preventing heart disease. He talked about up until vegans discovered it was necessary to take B 12 mini were dying just like meat eaters from heart attacks and heart disease. And all of the medical Community what degree that B12 is important for heart health. At one point everyone was hung up on cholesterol, and obesity, but the most recent findings suggest that inflammation is perhaps the greatest contributor to all health problems including heart disease. And one of the markers of information is that AA/EPA ratio. There are other measures of inflammation like calcium score and see reactive protein, but the AA/EPA seems to have some bearing, studies adjusting those with a ratio above 15 at high risk for a cardiac event/death. I’ll share this article with you and regardless of the fact that they do sell supplements, there are other scientific studies where you can find the same information.

        1. Do you think as long as one ate vegan and kept the omega 6 and 3 balanced,
          with no algae supplements, just flax seed/chia, that inflammation in regards to
          what you are suggestion would not be an issue?

          1. Nan,

            I’m not sure if I understand your question. Keeping the omega 6 and 3 balanced is important, adding algae supplements can only help. If you’re not pregnant, you are fine with just flax/chia, pregnant women’s (and maybe eldery) should add algae supplements, too.

            I hope that answered your question

            Health Support Adam P.

        2. I obviously agree that B12 is important for health… And inflammation ditto. How does that relate to long chain fatty acids? My understanding (and personal experience) is that inflammation is generally very low on a WFPB diet. The article you linked is about cancer, not heart disease and inflammation. You seem to suggest that cholesterol and obesity are no longer major CVD risk factors, which would be news to me.

          Im sorry, but I’m just not following your line of reasoning.

          1. Obesity, inflammation, toxic exposure, loss of structural integrity are all part and parcel of coronary heart disease. Calcium in coronary arteries is the result of plaque rupture always due to inflammation and an inflammation perpetuator.
            To give or not to give OM3FA is controversial. I do, not without documentation. Treating endothelium, calcification, etc is ill advised. Sleep, community, movement, relationships, nutrition, stress, environment all play a critical role. You cannot get well if you do not remove toxins from your body.
            Its a big mess, with what appears no way out. There are plenty of ways out. Eating clean nutrient dense plant based diet is not enough.

          2. Hi I’m a RN health support volunteer. If I may jump in here, the idea that cholesterol does not effect heart disease got popular some time ago. The “butter is back” movement.
            Some of those studies were actually funded by the egg and meat industry

            EPA and DHA supplements may not have been shown to help with heart disease, but a whole food plant based diet absolutely does.


        3. Dr Greger does not advocate so-called ‘vegan’ diets. He has been saying for many years that most ‘vegan’ and vegetarian diets are deficient in a number of areas. This video is from as long ago as 2003.

          He advocates whole food plant based dietst These are the diets that have been shown by eg Esselstyn and Ornish to not just prevent heart disease but actually reverse it.

          And cholesterol itself promotes inflammation by the way.

    2. Hello Dana,

      Thanks for your question. I believe there may be a small misinterpretation here. Dr. Greger suggests that based on the currently available balance of evidence, supplementation of long chain fatty acids do not help to prevent heart disease, but that does not mean we shouldn’t worry about heart disease. There is something else we can do about it! Eating a whole foods, plant-based diet is perhaps the most powerful tool we have against heart disease and is the only diet proven to reverse the disease.

      Now for brain function, Dr. Greger suggests that all women supplement 200mg of DHA during pregnancy for the baby’s neurological function. He also recommends 250mg for others consuming a plant-based diet as an insurance measure to preserve brain function long-term. Based on the available data, it may not be 100% necessary, but if you’re consuming your DHA from contaminant-free sources (Algal oil), then why not play it safe?

      I hope that answers your question,


      Reversing Heart Disease:
      Supplementing DHA in pregnancy:
      Supplementing DHA to preserve brain function:

  7. There is this a powerful Cochrane Report against Omega 3, “worthless.” In opposition to my practice and driving legitimate medical professionals, even liability concerns, away. Sad. Very Sad….
    Moving on, lets move on.

  8. I agree with the commenter on the expense of algae oil — I am paying for purity. The brand I’ve been using turns out to be only 175 mg of DHA and 88 mg of EPA. Better than nothing I suppose, but it is approximately $1/day and more if I adjust dosage for the 250 mg recommended. For seniors on a budget, that’s a lot. I guess it is worth it for brain health, although it tastes awful and is very oily. Given that I am avoiding oil, I find it particularly repulsive. Yup, it tastes like poison! And so I only have it sporadically. I do have 2 TBS of flax each day, and eat walnuts… here’s hoping that’s enough until I can find a brand that is less expensive (but still pure) and tastes better. I try to follow all of Dr. G’s recommendations — have his book and cookbook (okay, I”m a big fan!) — but this one causes me some trouble!

  9. Anyone who wants to dig in to the chemistry here, can look up articles by Professor Angel Catala, in the ‘Journal of Lipids’. A lot of interesting info if you are so inclined.
    But, bottom line, plant type omega 3’s are difficult for the body to convert to EPA and DHA. It takes 3 steps to convert alpha linolenic to EPA, and another 3 steps to convert EPA to DHA. I would suspect that some genetic groups, land locked for centuries, are better at this. People whose ancestors lived near sea coasts may not be able to do this as efficiently.

  10. Might be helpful to explain also that there are two essential fatty acids. Essential meaning we cannot make them, linoleic, an omega-6, and alpha-linolenic, an omega 3. They compete for absorption and elongation to other forms. Arachidonic for the 6, DHA for the 3. So if you get a lot of omega 6 in your diet, you convert less omega 3 plant oils to DHA.

    1. Marilyn is correct.

      It is probably not enough to increase ALA consumption, it is also necessary to substantially decrease LA consumption And perhaps aim for a 1:1 ratio or at least less than 1:2

      Jack Norris has an excellent long article on this broad topic but these 3 paras seem particularly relevant

      ‘A 1999 study on Japanese (23) elderly subjects gave them 3 g ALA per day and reduced the omega-6 to omega-3 ratio to 1:1. After 3 months, there was no difference in EPA and DHA levels, but after 10 months, EPA levels had risen from 2.5 to 3.6% of serum lipids, and DHA levels rose from 5.4 to 6.4% (both findings statistically significant).
      Welch et al. (24) reported that non-fish eaters (both vegetarians and meat-eaters) convert ALA to long chained omega-3s at a slightly greater rate than do meat-eaters, so conversion rates of vegetarians might be greater than these studies on meat-eaters show.
      In summary, it appears that 3 g (the equivalent of about 1-1/2 teaspoons of flaxseed oil) per day of ALA cannot increase blood percentages of DHA in three months time, but can increase blood percentages in 10 months time, assuming intake of omega-6 is low.’

  11. Okay, so you have helped me to figure out B-12 and now you are going to help me to figure out fish oil.

    Not there yet.

    I watched your “Behind the Scenes” video and I want to thank the 19 researchers who are working diligently to figure these things out.

    I pondered the oily fish and prostate and endothelial cancer study, which got retracted for conflict of interest and I am wondering if you have a yellow “caution” file where possibly true, but retracted information goes or is the whole thing thrown out.

    I don’t throw things out.

    Walking through this whole Cancer thing, I haven’t been giving my dog B-17, but the images of the dog’s foot here is in my symbolic “yellow” file:

    Green tea has moved from my green file to my symbolic “walk” signal for the tea because it takes away from drinking other things, like the turmeric drink, which might be more effective and it the supplements are in the solid “red” light.

    Yes, I am trying to do your red light/green light process and I need a whole town with a bike path and crosswalks and a train station and airport to figure things out.

  12. Can some of us get email copies of the studies, which are powerful, but not entertaining? I can send them to the singing science music video guy. If he can make a music video version of the Kreb’s Cycle, he can make anything entertaining.

  13. Is there an acceptable amount of flax or chia seed that would/could negate the need to take the supplemental DHA/EPA? I assume there is also a difference in the amount of whole grain (5gm fat/tablespoonful) vs the available “defatted” flax seed meals (1.5gm fat/tablespoonful) being sold necessary to get the proper amount of ALA. I’m assuming the one tablespoonful being mentioned in the blog is for the whole grain version of flax seed meal.

  14. Dr. Greger, What about prescription fish oil? My doctor, fearing the contaminated fish and fish oil supplements, prescribed Omega-3-Acid Ethyl Esters Capsules, 1000mg, each caps containing 465 mg EPA and 375 mg DHA. I believe this might be synthetic and also insurance doesn’t cover. Any comment on this please?

  15. Ethyl ester omega-3 are actually derived from fish oil. A process is applied that concentrates the omega-3s. They provide higher dose DHA/EPA in a single capsule. Dr Greger would suggest an alternative to fish oil, with DHA/EPA from algae, which is where fish themselves get their omega-3s. EE omega-3s are to be avoided in those with sensitivity to fish and shellfish, although it’s not known if there is cross allergy.

  16. How does Flaxseed oil as a source of Omega-3 compare to the other sources? Doses listed on NatureMade FSO compare to my fish oil capsules but also include some Omega 6 and 9.
    No DHA/EPA is listed.

  17. Hello Robert, thanks for your comments.

    Flaxseed oil don’t have DHA/EPA; instead, it contains a third and plant-based omega-3, alpha-linolenic acid (ALA). ALA can be converted to DHA and EPA, however, conversion is limited and affected by multiple factors such as age, smoking, gender, disease, and other dietetic-related factors.

    Hope it helps

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