Should Vegan Women Supplement with DHA during Pregnancy?

Should Vegan Women Supplement with DHA during Pregnancy?
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I recommend all pregnant and breastfeeding women follow the consensus guidelines to get about 200mg of preformed DHA from a pollutant-free source.

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A systematic review of randomized controlled trials of DHA supplementation of pregnant and breast-feeding women failed to find any clear and consistent short or long-term benefit for psychomotor, mental, visual, or physical development.

Maybe DHA supplementation during pregnancy had no effect because the body isn’t stupid and protects the growth of the baby’s brain by drawing off of maternal stores of DHA, upregulating maternal DHA synthesis, and preferentially shuttling it to the fetus, but what if moms don’t start out with large maternal stores?

In other words, maybe DHA failed to help women who were already getting enough, but maybe women with very low intakes would benefit. Well first, it’s interesting to note that even by 1978 researchers were suggesting plant-based diets as the diets of choice in the treatment of our number one killer, but babies breastfed by vegan moms had significantly less DHA in their bloodstreams, presumably because they had significantly less DHA in their breastmilk.

The question is whether these differences are of any consequence? The growth and development of vegan and vegetarian children are normal, as long as they’re getting their B12; no evidence that neural or intellectual functions are impaired. In fact, the two studies we have on vegetarian kids showed they had even higher IQ’s, though that may be because their parents tended to be better educated. But even though the kids seemed fine, that doesn’t rule out the possibility that there may be some subtle differences in visual or neural function.

It would be interesting to compare the function of babies getting vegan breast milk levels versus general population levels. You can see vegans had 14,  vegetarians 30, and omnivores 37. This study compared zero to 32, 64, and 96, and 32 worked better than zero, but more than 32 didn’t add anything. This could explain why the general population at 37 doesn’t benefit from additional DHA supplementation, but what about down at 14? Most studies down at that level show no advantage over zero, though one study found a benefit supplementing at as low as 5, but that doesn’t help us.

Now, just because babies breastfed by vegan moms have significantly lower DHA levels in the blood, that doesn’t necessarily mean they have lower levels in their brain, which is where it counts. What we need is a randomized, controlled trial in non-fish-eaters of DHA supplementation. Until then, it’s going to remain uncertain. So, what should pregnant and breastfeeding women who avoid fish do in the meanwhile? Low intake of DHA doesn’t necessarily equate with fetal DHA inadequacy, but these new data suggest that some infants may not be getting enough and could benefit from their moms supplementing; and so, I recommend pregnant and breast-feeding women on plant-based diets do follow the consensus guidelines to get about 200mg of preformed DHA from an uncontaminated source, like algae oil, which is probably the best combination for all women given the state of our world, to minimize exposure to toxic pollutants such as dioxins, PCBs, and mercury. 

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Bollepret.

A systematic review of randomized controlled trials of DHA supplementation of pregnant and breast-feeding women failed to find any clear and consistent short or long-term benefit for psychomotor, mental, visual, or physical development.

Maybe DHA supplementation during pregnancy had no effect because the body isn’t stupid and protects the growth of the baby’s brain by drawing off of maternal stores of DHA, upregulating maternal DHA synthesis, and preferentially shuttling it to the fetus, but what if moms don’t start out with large maternal stores?

In other words, maybe DHA failed to help women who were already getting enough, but maybe women with very low intakes would benefit. Well first, it’s interesting to note that even by 1978 researchers were suggesting plant-based diets as the diets of choice in the treatment of our number one killer, but babies breastfed by vegan moms had significantly less DHA in their bloodstreams, presumably because they had significantly less DHA in their breastmilk.

The question is whether these differences are of any consequence? The growth and development of vegan and vegetarian children are normal, as long as they’re getting their B12; no evidence that neural or intellectual functions are impaired. In fact, the two studies we have on vegetarian kids showed they had even higher IQ’s, though that may be because their parents tended to be better educated. But even though the kids seemed fine, that doesn’t rule out the possibility that there may be some subtle differences in visual or neural function.

It would be interesting to compare the function of babies getting vegan breast milk levels versus general population levels. You can see vegans had 14,  vegetarians 30, and omnivores 37. This study compared zero to 32, 64, and 96, and 32 worked better than zero, but more than 32 didn’t add anything. This could explain why the general population at 37 doesn’t benefit from additional DHA supplementation, but what about down at 14? Most studies down at that level show no advantage over zero, though one study found a benefit supplementing at as low as 5, but that doesn’t help us.

Now, just because babies breastfed by vegan moms have significantly lower DHA levels in the blood, that doesn’t necessarily mean they have lower levels in their brain, which is where it counts. What we need is a randomized, controlled trial in non-fish-eaters of DHA supplementation. Until then, it’s going to remain uncertain. So, what should pregnant and breastfeeding women who avoid fish do in the meanwhile? Low intake of DHA doesn’t necessarily equate with fetal DHA inadequacy, but these new data suggest that some infants may not be getting enough and could benefit from their moms supplementing; and so, I recommend pregnant and breast-feeding women on plant-based diets do follow the consensus guidelines to get about 200mg of preformed DHA from an uncontaminated source, like algae oil, which is probably the best combination for all women given the state of our world, to minimize exposure to toxic pollutants such as dioxins, PCBs, and mercury. 

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Katie Schloer.

Please consider volunteering to help out on the site.

Images thanks to Bollepret.

Doctor's Note

To gain a better understanding of why algae oil is better than purified fish oil, I encourage you to watch my video Should Pregnant and Breastfeeding Women Take DHA.

What about taking long-chain omega-3s to protect our heart? See:

I’ve discussed concerns about pollutants in seafood during pregnancy in a number of my videos:

If you haven’t yet, you can subscribe to my videos for free by clicking here.

102 responses to “Should Vegan Women Supplement with DHA during Pregnancy?

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  1. The preformed DHA saga continues with a reiteration for the recommendation for 200 mg from uncontaminated sources such as algae oil to be on the safe side.
    A tip of the hat goes out to the biochemical intelligence of the human body for its ability to cope with a wide variety of short chain omega-3 inputs to synthesize sufficient DHA by upping production.
    Smoking gun research link between preformed DHA supplementation and benefit still elusive.
    Brest is still best regardless.

  2. Speaking about DHA…..fish…ocean….how about concerns regarding transdermal absorption of toxins, mercury, harmful algae, nano-plastic materials, etc. saturated our oceans? Can these toxins, plastic nanoparticles, etc. pass through the skin?
    How about mercury in oceans….transdermal?

    1. I dyed my hair black for my husbands 40th birthday and my infant son who I was breastfeeding broke out in a rash, so I know that a large dose of anything toxic can be absorbed through the skin. I would be more concerned about the day to day products you are using on your skin and hair (all of which is untested and unregulated) than the amount of toxins you might absorb by swimming in the ocean.

      1. Holy cow! Even more of a reason why ocean swimming might be harmful. If skin is that transdermal, seems likely mercury and algae toxins would be passing through skin layers and into bodily organs. Yikes, mercury, cadmium, synthetics, hormones, yuck.

        1. No, I don’t think it’s concentrated enough; but I could be wrong. Hair dye is very unhealthy though. One of the worst occupations to be in as far as toxicity is a beautician.

          1. Although we’ve ventured a ways from nutrition, the point you make, Sylvia is valid- when considering our health we must consider all our actions, including food intake AND potential exposure to hazardous environments/chemicals, is a valid one. However for all our readers who dye their hair, I don’t want you to have it turn instantly white in fear. The results on safety of hair dye are mixed. You might want to check out
            this link: http://www.cancer.gov/about-cancer/causes-prevention/risk/myths/hair-dyes-fact-sheet#q2

            1. It’s the exposure on a daily basis that is a hazard, so tip your beautician well; and oh yeah breast feeding or pregnant women might want to wait until that period in their life is over before getting their hard done again.

            2. Actually the environmental working group has rated hair dye products for their safety. So, if you are using hair dye, then this is a reference that you can use to see how well the product you wish to use holds up: http://www.ewg.org/skindeep/browse.php?category=hair_color_and_bleaching&&showmore=products&start=680

              I am sure our government would never advise us to use anything that is harmful, (like animal products) but the reality is that our government is underfunded and corporate interests have their say in the recommendations we are given.

              You don’t have to be afraid if you are informed.

    2. Hi, that is a very interesting question. For most toxins entering the body it involves inhalation or ingestion. Absorption through the skin is moving a little out of the realm of nutrition, however I have included a link to the ATSDR where you can search individual toxins and their toxic effects
      http://www.atsdr.cdc.gov

      1. Also, regarding, the comment about hair dye or other household products and their toxic effects, information can be found at the link I provide above or in the case where medical advice may be required from a potential exposure, from your regional poison centre

      2. I think this is extremely relevant issue for Dr. Greger to address, as even the “best” vegan diet for avoiding toxins might be being negated by simply being an avid swimmer in the ocean, thinking all is okl when one might be absorbing even more and worse toxins than they would with no ocean swimming and minimal animal product consumption.

        1. The concentration of toxic pollutants in the ocean is alarming in terms of the environmental and potential health effects. The concentrations that we ingest becomes higher as the trophic level or position in the food chain increases. There are relatively low concentration in sea water which may be incorporated by algae, then to herbivorous fish, crustaceans, molluscs etc, then smaller carnivorous fish and so on until we get to high trophic levels for fish like tuna or sharks where there has been a bio-accumulation of a particular toxin such as mercury. This ingested level can be far higher than the level in the sea, where the the particular toxins may or may not have the ability to cross the skin barrier.

      3. A lot of people are using coconut oil as a skin moisturizer to avoid all the chemicals in skin products. But isnt some of that saturated fat getting absorbed into the bloodstream?

    3. The parts per million of marine toxins like mercury are around 0.0003 ppm. This is two orders of magnitude lower than arsenic. The concentration of uranium is even 5 times higher than mercury. The aquatic food chain goes from untold trillions of square meters of surface area of algae in contact with sea water that starts the process which then gets concentrated as it goes up the food chain. Even assuming 100% absorption of the mercury that does come into contact with your comparatively tiny skin surface area would result in a very trivial amount of mercury. For comparison the FDA allows cosmetics to contain up to 1 ppm, 3333 times amount found in sea water, to be in full contact with your skin.

      So I don’t think the amount of mercury that would be absorbed while swimming in the ocean would be of any concern. I would bet the same is true for most other toxins.

      1. For mercury and heavy metals, what you say makes sense, but exposure to viruses, bacteria, sludge waste, domaic acid issues, etc. I’d think might be a big deal.

        1. IMHO, When your skin doesn’t block the viruses and bacteria you will have an infection…. Salt water contains a different ecosystem than freshwater so unless you’re swallowing the water/sludge, or exposing yourself to high coliform (untreated sewage) the risk of exposure should be minimal. Minimize known toxin intakes, be skeptical about super foods and supplements, eat a plant strong diet and live your life.

      2. That is true in principle.
        On the other hand, most people swim in coastal waters rather than deepwater ocean. These can be more heavily contaminated. Here in Australia for example, pesticide, fertiliser and herbicide run-off from farmlands enters coastal ocean waters and damages the Great Barrier Reef. I doubt whether it does local swimmers much good either..
        Further South, in Sydney, minimally treated sewage was just dumped into the ocean. However, tides can bring the effluent back inshore again. At the famous Bondi Beach, the visible results of this were called Bondi Cigars … brown, cigar-shaped objects. About 25 years ago, though, they moved the sewage outfalls further offshore so the problem is not so visible now.
        To be frank, I don’t know whether this is a significant problem or not but it probably depends on local water conditions.

        1. Tom, I agree that swimming in heavily polluted in-shore waters is a completely different issue. But I still don’t think that direct transdermal absorption of metals toxic metals like mercury that are the primary hazard from eating fish would still be an issue. I would think the health hazard from agricultural run off and poorly treated sewage would come from bacteria and organotoxins like insecticides that are very deliberately designed to be potent neurotoxins and readily absorbed. And here in the Great Lakes region of the US a growing hazard to bathers is toxic algal blooms that are a secondary effect of agricultural run off (mostly from farms growing corn and soy to feed to livestock).

    1. Susanelizabeth Turner: Dr. Greger doesn’t usually recommend specific brands of anything. But my understanding is that the algae based DHA supplements are all made from algae in controlled tanks. Contamination should not be an issue. So, I suggest finding the one that works best for you in terms of cost, convenience, pill size, etc.

        1. plant_this_thought: It is my understanding that pretty much all the various brands of algae DHA/EPA pills are made at the same one or two places. So, it really doesn’t matter which brand you get. It all comes from the same source with different stickers slapped on the bottle. That’s my understanding anyway.

    2. If you read the packaging labels or material or visit the website of the manufacturer you usually get their info. When I was looking into this a few years ago, at that time all of it was manufactured at a just two or three companies and sold as an “ingredient” to the name brand companies who then packaged it for consumer sales. In all of the ones that I reviewed at that time they stated that the algae was grown in controlled environments (large steel containers) free of any contamination. So no toxins had to be removed later. You might find this article from Algae Industry Magazine helpful. If you find a few brands that look good. You can go to their websites and contact them via email and ask about their purity process and testing. I found that almost all of them cheerfully replied or already had the info posted on their site. Good luck.
      http://www.algaeindustrymagazine.com/the-global-algae-oil-omega-3-market-in-2014/

      Mark G

      1. Dr. Fuhrman’s DHA/EPA has no carrragenan or glycerin. It does have some amount of sunflower oil, sunflower lecithin, and a few other ingredients. But the amount of these additives would be miniscule.

  3. Based on your conclusions, it seems that women prior to the availability to DHA supplementation or those who live in third world countries where plant foods are the ones mostly available, had no chance of a normal pregnancy. However your statement that the body isn’t stupid makes much more sense. Instead, I’m inclined to believe that supplementing with DHA is stupid. Long chain Omega 3’s don’t protect against heart disease or cognitive decline, Dr. Mcdougall mentioned that the may cause cataracts and other problems, and they’re often polluted, rancid and seldom contain the advertised dosage. My decision therefore, is to a couple of rounded tablespoons of flax seed a day in my smoothie, and let my body in its wisdom decide how much of it that it wants to convert into long-chained omegas.

    1. On what basis do you state that long-chain Omega-3s don’t protect against cognitive decline? There are several papers out there that correlate DHA intake with later positive cognitive results. Perhaps not so apparent in short term studies, but such is the case with many natural products. Personally, after being a vegan for 30 years I found that starting algal Omega-3s dramatically improved my cognitive clarity. I don’t understand the hesitancy to acknowledge that they may be helpful – they are ultimately derived from plants and vegan sources are available.

      1. I think that some, but certainly not all of the reluctance to acknowledge the health benefits from any supplement to a plant-based diet comes from the criticism made by omnivores that the need to supplement a plant based diet means that it is nutritionally incomplete and therefore not healthy. And that to be healthy you have to eat meat and eggs (and if not paleo drink dairy). So the reluctance of people eating a plant-based diet to acknowledge that anything other than whole plant foods is needed for optimum health, save a B-12 supplement, and sometimes not even that.

        Of course it does not logically follow that just because a supplement to a WFPB diet *might* results in better health outcomes, that an omnivorous diet is healthier. It is of course entirely possible for a WFPB diet to be more healthful with a supplement and still be vastly more healthful than an omnivorous diet. But I have seen numerous omnivorous commenters here and on other sites gleefully seize on any perceived “flaw” in a WFPB diet to justify their own meaty diet.

    2. Agreed. This would be settled if they did a study on vegans eating the recommended amounts of fruits, vegetables, greens, and beans, with some flax to top it off. With a low enough omega 6 to 3 ratio too. I’m confident that they would find it to be more than sufficient for all optimal benefits.

  4. What if they are consuming adequate omega-3 from plants such as greens, beans, fruit, and flax, and have a proper omega-6 to omega-3 ratio?

  5. Hello Dr. Greger and community – I’m a newly practicing vegan and breastfeeding mum, I’m hoping you could tell me overall what supplements are best to take at this point – The doctors here recommend the multivitamin standard supplement for Mums and Mums to Be.

    Thanks guys stay healthy :)

    1. Maggie: Congrats on your new little one! A good source for kid related nutrition information (and a source that I believe I’ve seen Dr. Greger recommend as well) is Vegetarian Resource Group (VRG). Here is a link to their page on families/children. Scroll down to the nutrition section.
      http://www.vrg.org/family/kidsindex.htm

      I think VRG generally has some solid information. Another source of good information for this topic is the Physician’s Committee For Responsible Medicine (PCRM). I don’t have a specific article in mind, but you might see if any of these links have what you are looking for:
      http://www.pcrm.org/solr/breastfeeding

    2. Dr Greger has reviewed multi-vitamins studies before and the correlation of taking multi-vitamins to be correlated to greater mortality from all causes. I speculate that it’s from all the synthetic vitamins used, and the fact that some of the ingredients all come from China which has a low standard. Also, the federal govt came out with findings a few years ago that the amounts and ingredients listed on the box of supplements didn’t match and that in about half the test there was little or none of the stated ingredient(s). Folic acid, a synthetic form of folate, is particularly bad on most bodies and should not be taken in doses above 100% daily recommended levels. I won’t touch the stuff. If it was me, and I was eating a healthy, whole-food, vegan diet with a good variety of foods, I wouldn’t worry about the supplements unless my doctor said I was low in something. You might also want to see what doctor McDougall has to say about it.

      Here is Dr Greger’s list of daily supplements: http://nutritionfacts.org/2011/09/12/dr-gregers-2011-optimum-nutrition-recommendations/

      I hope good health for you and your baby.
      Mark G

      1. Most people who eat the standard diet know that it isn’t good for them, but they can’t or won’t eat better, and so they take a multi-vitamin with the hopes that it will make up for the crap they eat. It doesn’t and so multi-vitamin consumption ends up serving as a marker for those eating themselves into an early grave.

        1. I so agree Jim! Everyone I know has an array of vitamins and supplements that would rival the display at any drugstore, it’s pathetic. If I could have a super power for one day, I would just want to wake these people up!

      2. I unfortunately think vitamins are safe, effective, beneficial, economical, and demonstrably successful at specific purposes. Vitamin C has been shown in at least a dozen studies to be related to longevity. No one has studied three grams or more for longevity. The study Dr. Greger sites, about Centrum, was made by a drug company to make more money for its drugs. Another study found multivitamin users have teleomeres that were 50 percent longer. This is perhaps the most profound benefit a vitamin can have. The shortcomings of multivitamins are often based on the nutrients that they have less of, or are a problem with the government’s RDA. The government has a supplementation program, with respect to Niacin, Iodine, B12, folate, and others. Most people are deficient in these. The Vitamins required by law to be listed on every label, Vitamin A, Vitamin C, Calcium, and Iron are probably also needed in macro amounts by most people, even those on a vegan diet. Perhaps with these vitamins more is truly better.

        1. Hello Matthew-
          You make some some good points. And I know that the Linus Pauling Institute’s website has always tauted the benefits of vitamin C. My concern is with (a) synthetic vitamins, especially those with ingredients sourced from China (ingredients don’t have to show source of origin if manufacturing is in another country); (b) the efficacy of any given vitamin brand; and, (c) the excretion of the body beyond what’s needed. Some vitamins can impact the absorption of other nutrients. I take supplements, mostly those listed by Dr Greger. But I try to take low doses and I try to get all of my nutrients by eating the most nutrient dense foods I can.

          As an aside, I think it was Dr Weil who pointed out that 40% of the population is allergic to folic acid (the synthetic form of folate) and that everyone reacts negatively to folic acid and when it’s taken at more than 100% of the recommend daily allowances. He and others note that the synthetic form has been tied to cancer risks as well.

          Anyway, those are my thoughts. But as I said, I think you raise some good points. Thanks for the note.
          Mark G

    3. Hi Maggie, I see you’ve already gotten some good resources from others, but I’m just adding Dr. G’s recommendation from the above video. Don’t forget to supplement with algae oil during this important phase of your (and your little one’s) life. There are several comments above about various brands of algae.

      1. No one has made any brand recommendations yet… Anyone willing to supply the name of a tried and true brand, both economical and of high quality?

    1. From what I can see, it looks fine and fits the recommendations of Dr. G’s video above. However, I don’t see, either in the text or picture, what the inactive ingredients are in the product. Personally, I have used other products from the same manufacturer, Genestra, and believe they are fine. I would like to assume that this one should be OK too, but I can’t give it my “blessing” since I can’t see all the info. You may want to call the company and ask for the full ingredient list.

  6. The parents are better educated so the children have higher IQ? Sounds like Lamarckism, but I expect that was not what you wanted to say.

    1. IQ is in part nature and in part nurture. “Better educated” is a proxy for higher income and thus more resources to help enhance the nurture part. And even independent of income, better educated indicates a higher value assigned to intellect and so more of the available resources (which includes time) are directed at nurturing of intellect.

      1. Yes, I know. The point of my comment concerns poor phrasing by Dr Greger that makes it sound as if he believes in Lamarckism.

        1. Well with the growing understanding of the heritability of epigenetics changes to the genome something very Lamarckian in external appearance might be at play. It is hard to see a biological method connecting eduction and epigenetic changes in the genome effecting IQ. But if we assume that education level is just a reasonable marker for nutrition level, and assuming that nutrition level has an epigentic impact of genome of the parents in areas effecting brain development. After all our very metabolically expensive brain could be a liability for any person living with chronic malnutrition. So it isn’t completely out of the question that the any epigenetic changes in the parents is not be completely undone in the germ line and so the eduction level of the parents could have a biological impact on IQ of their offspring. Actually the education level of the grandparents might be more important because that could effect the nutrition level of the parents during their development and so could leave epigenetic changes that could be passed on in some form to the grandchildren.

          But you are undoubtedly correct in that Dr. Greger was not implying any Lamarckian connection between educated parents *wanting* smart kids and so, like the giraffe who *wants* to eat leaves higher up on the tree giving birth to longer necked offspring, give birth to smarter children.

          1. Yes, you are right. But as you must know (you seem quite knowledgeable) epigenetic inheritance is rather limited. It plays a role in immunological inheritance, and may alter the expression of some other genes as a result of such factors as diet (especially stress due to starvation, disease or trauma), as you mention. But they do not actually change the DNA. They alter DNA binding proteins, usually by methylation on certain binding sites, that alter the expression of those specific alleles. People who know a lot less than you may be misled into thinking that education of parents leads to greater IQ in their offspring, from the wording employed by Dr. Greger.

  7. Dr Greger and fellow fans of nutritionfacts.org!

    What are your thoughts on the Vegan Society’s multivitamin, VEG1? It appears to cover the nutrients recommended on this site, while leaving out the culprits. Input would be much appreciated!

    https://www.vegansociety.com/shop/supplements/veg1-orange-90-tablets

    Vitamin B2 (1.6mg – 114%)
    Vitamin B6 (2mg – 143%)
    Vitamin B12 (10µg – 400%)
    Vitamin D (10µg – 200%)
    Folic Acid (200µg – 100%)
    Iodine (150µg – 100%)
    Selenium (60µg – 109%)

    Ingredients: Sugar, Dextrose, Acacia, Selenomethionine (Selenium), Stearic Acid, Flavour (Orange), Ergocalciferol Preparation (D), Pyridoxine Hydrochloride (B6), Magnesium Stearate, Riboflavin (B2), PVP, Folacin (Folic Acid), Potassium Iodine (Iodine), Cyanocobalamin (B12).

    1. I personally don’t see any need for any supplement other than B-12. My view is that supplements are only necessary if you are eating a nutritionally deficient diet. Every bell curve has its tail and there will be some folks with metabolic differences that interfere with absorption or utilization that might not be able to fully thrive on an unsupplemented diet. For those folks supplements might be in order. But I can’t see that supplements are needed for the majority of people unless of course they getting a significant portion of its calories either from animal foods and nutritionally denuded plant foods.

      Also the trouble I see with multivitamins is that they contain vitamins and minerals at very high percentages and at very artificial ratios to each other. It is sort of like every instrument in an orchestra playing all at once and at the same high volume. Health, like music, can be all about the subtleties and nuance.

      All that said, I can understand why an organization like the Vegan Society carries a vitamin and mineral supplement and that is because a lot of vegans eat an absolutely atrocious diet and would fall into ill-health if they didn’t do at least something to fill the nutritional voids in their diet of highly processed plant foods. And if a lot of vegans start becoming ill explicitly because of their diet that would be a real black eye for veganism.

      So unless you are a junk food vegan trying to live on pretzels and beer, or you have been diagnosed by a doctor with a blood test to be critically deficient in a given nutrient, I would steer clear of any supplement (again other than B-12).

      1. All good points – thank you!

        My personal concerns – besides B12 – are D (I live way up north) and iodine (I hear that even a balanced, whole foods plant diet may be deficient, if soils are poor).

        On the other hand I totally respect your position, and in a way it would be a big stress relief to *only* supplement B12 and be done with it. :)

        1. Iodine deficient soils are very localized, so it is likely to only be an issue if you go 100% “localvore” and live in a place like the Great Lakes region of the US. If you get food from a range of locations, it is actually pretty easy to get enough iodine. But the use of iodized salt even in the small 1000-1500 mg amounts we should actually be eating plus that naturally occurring in foods should be more than enough.

          D is an interesting issue. I have often wondered if the answer to living with little or no sunlight exposure isn’t a small “tanning” lamp a few times a week for 10-15 minutes rather than a pill. Like others have said, your body is pretty smart and will regulate the amount of vitamin D to that it currently needs if given the opportunity. D is a potential issue only because we don’t give it the daily sun our ancestors used to give it.

          1. I thin it depends where you live and what you eat. I live in Australia and like the UK, salt is not always iodised. Certain parts of the country, like NZ, are also noted for fairly widespread iodine deficiencies.
            http://www.foodstandards.gov.au/code/proposals/documents/The%20prevalence%20and%20severity%20of%20iodine%20deficiency%20in%20Australia%2013%20Dec%202007.pdf

            It is, however, now mandatory to use iodised salt in commercial bread making – EXCEPT for organic breads.

            Consequently, it is still possible for somebody eating a wholefood (organic) plant based diet who lives in the most populous parts of Australia to be iodine deficient. I suspect that the same may be true of minerals like selenium etc etc

            I do take a food-based multivitamin that contains B12, iodine etc. (but no iron). It is a decision I made in line with Bruce Ames triage theory. There is a summary of his argument in a 2006 paper published in the (US) Proceedings of the National Academy of Sciences (so, it is not one of those out-there internet dietary theories). On the other hand, I recognise that there may also be risks from consuming too much of any particular vitamin/mineral and that Ames’ ideas are particularly relevant to people eating largely junk food diets and not so relevant to people eating varied whole food diets.
            http://www.pnas.org/content/103/47/17589.full.pdf

            I think therefore that this area still remains one for personal decision based on individual circumstances. If one eats a very varied diet of plant based foods from many areas/countries, a multivitamin is probably not necessary but for people who don’t (including “locivores”), a good vegetarian food-based multivitamin is IMHO worth considering.

        2. Dr McDougall says that if you live where trees and plants can grow and photosynthesize in warm weather, you can get enough Vit. D., which makes sense to me since plants rely on sunshine alone to metabolize, and we rely on plants and some sunshine for a portion of ours. The darker your skin, of course, the more you would need, but Vit D levels alone are not a marker of sufficient sunshine, there is more involved.

        3. Any kind of pain could be an Iodine deficiency. Beware. One of the side effects of Iodine is a weak pulse. I have not felt my heartbeat for a year since I took Iodine supplements.

      2. “Also the trouble I see with multivitamins is that they contain vitamins and minerals at very high percentages and at very artificial ratios to each other. It is sort of like every instrument in an orchestra playing all at once and at the same high volume.”

        Good analogy. :-)

      3. The benefits of supplementation are numerous. Soils are very depleted in nutrition. I do not think a vegan diet and B12 could return a sick person to health quickly. Vitamins might be a perfect solution to many health problems,. Sickness is probably nutritional. A vegan diet can add 10 years to life. Vitamin C and Niacin supplementation, in orthomolecular doses, has added dozens of years to several people. Vitamins put me to health. The idea that supplementation is harmful is not based out. Supplements, food, and harmless might be the same concept. Misconceiving harmless as harmful seems to be a catch stone in nutrition studies.

    2. I started taking a B complex supplement about two years ago, after I began experiencing neuropathy in my hands. This condition was resolved a few days after taking the B complex supplement. My diet is inconsistent. Although, I very rarely eat snacks or “junk” food, some days I may eat 4 or 5 servings of greens, another day, I may have a single serving. The same goes for nuts, seeds, sweet potatoes, beans, etc… The B vitamins are particularly important for mitochondrial maintenance and function. So be sure that there are sufficient quantities in your diet. I eat one to three cruciferous vegetables daily, so I take a supplement with iodine periodically. Regarding vitamin D, Dr. Greger has quite a few very interesting and insightful videos on this.

  8. Hello. I will be acting as the volunteer moderator for this site for the next two hours and look forward to your comments and the opportunity to answer questions or guide you to the right source.

  9. Is it still necessary to supplement if you do get enough? I put 4 tablespoons of flax in my green smoothie every morning and eat a large handful of walnuts every night. I just looked this up, and it seems that 1tbs of ground flax seeds gives you 1597 mg of Omega 3. And 100g of walnuts gives you 1079mg Omega 3. If the recommendation is only 200mg, aren’t I already exceeding the requirement by a lot? Am I misunderstanding the numbers? Please help!

    1. Great question. I also eat lots of flax and walnuts; AND I nursed a toddler and grew an 11lb 2oz baby (no gestational diabetes, which is common in very large babies) while eating a WFPB diet. With a giant baby like that, I would find it hard to believe that I was deficient in anything. :)

    2. Hi JoanneZ: Here’s what Dr. Greger says in his book How Not to Die:”According to how of the most credible nutrition authorities…you should get at least a half a percent of your calories from the short-chain omega-3 ALA. That’s easy–the one Daily Dozen tablespoon of ground flaxseeds takes care of that.Your body can then take the short-chain omega-3 fro flaxseeds (or chia seeds or walnuts) and elongate it into ..EPA and DHA. The question, however, is whether the body can make enough for optimal brain health. Until we know more, I recommend taking 250 mg of pollutant-free long-chain omega-3s directly.”

      The phrase “until we know more” says a lot. This is still an educated guess. As you can see from the discussion below, not all WFPB followers agree with taking this supplement. Given you are eating significant amounts of flax and walnuts, you’re probably good with just diet.

      1. You’re right that there is some controversy about flax in pregnancy. Flaxseeds are broken down in the body into chemicals called lignans that are similar to the hormone estrogen. This has lead some physicians to recommend caution, but most sites I looked at said flax in moderation is fine. Pregnancy women should consult with their own health care provider for advice on this.

          1. As always, speak with your healthcare provider about your specific situation. If you’re pregnant it may be prudent to keep flax to 1 tablespoon per day, in line with Dr. G’s general guidelines (which are not specific to pregnant women, but also doesn’t specifically exclude them).

    1. HI John- Please see my response to JoanneZ (4 posts down) about Dr. Greger’s recommendation on this from his book How Not to Die. Based on current knowledge, he does recommend a clean (algae) omega-3 supplement for everyone. Here’s another video on the topic: DHA supplements

  10. Hi all, just wondering if anyone could please advise on the correct level of vegan DHA supplementation for my two sons (6 & 9)? Thank you in advance – obtaining algae based omega supplements specifically for children seems rather challenging here so I’m going to have to break open my capsules for them and I don’t want to overdose them.

    1. I am not a medical profession, so this is strictly a lay persons understanding, but for a food item with little or no side effects in the amounts we are talking about here (I have read that in high dosages omega-3 fatty acids can slowing blood clotting but that is in the many grams level per day and not sub gram levels) and which has been part of the diets in populations since there have been humans, I would say that you could scale the amount based on their weight and the assumption that the adult dose is appropriate for a 150 lb adult. So a 50 lb child would take 1/3 the adult dose. Especially for fats and fat soluble items which the body is able to hang onto amount in excess of immediate need pretty well you can probably do short term time averaging. So if a recommended adult dose is 200 mg and you can only find 200 mg capsules, you could probably do OK with one capsule every third day for the above hypothetical 50 lb child.

      If I am completely off-base, I hope that one of the RDs or MDs that read this will chime in.

    2. Susannah: I don’t know the correct levels to give kids, but I’m thinking you might want to look some more for kid-appropriate products. I found the following on amazon: http://www.amazon.com/Ceregumil-Physical-Development-Vitamins-Maintain/dp/B00TTWU9J2/ref=sr_1_2_a_it?ie=UTF8&qid=1460494790&sr=8-2&keywords=dha+kids+algae I’m not saying this particular product is good. All I’m saying is that it is formulated for kids (being a liquid they could drink rather than have to swallow a pill) and it is algae-based. This type of product may be something you could look into once you figure out the dosages you want. That would be easier than breaking open an adult pill. Good luck.

      1. Hi Thea,
        Thanks for your kind reply. I’ll have another trawl through for vegan omega for children. The one you linked, unfortunately, has added vitamins, which I don’t want to give them as they have a good, varied, plant based diet (thanks to NutritionFacts!).

  11. Hello. I’ve just spent the last hour reading many of the comments on Dr. G’s two recent videos about DHA. I am a family doctor, not a nutrition expert but have been learning all I can over the past year or so. This topic of supplements one should consider during pregnancy is a very charged issue; pregnant women feel such a huge responsibility toward their unborn child. It can feel overwhelming to try to make sense of all this — it does to me! Before rushing out to find the best DHA supplement, and trying to keep in mind what is the source of the DHA, and whether it might be contaminated, and whether the supplement maker is reputable, and whether the oil might have turned rancid, and whether you should consider an oil that also has EPA, and whether taking it along with other vitamins is a good idea, etc., etc., it may be helpful to keep in mind a few general principles. Some of the comments, below, allude to this. Eating a whole foods plant based diet, using a wide variety of foods, will supply you with almost everything you need to stay healthy, and to give your unborn child the best start in life. We in medicine have had a great tendency to be reductionist in our approach to nutrition: focusing on what are the necessary individual ingredients for health: what amino acids, what vitamins, what minerals. This has led to the huge supplement industry out there. There are a very few ingredients in which a WFPB diet might be deficient: vitamin B-12, vitamin D (for people who don’t get enough sunlight), and now Dr. G. is raising the issue of supplementing the diet of pregnant women with DHA, and it seems that we don’t really have sufficient information to fully evaluate this. So, my educated guess about a wise approach would be to try to get your DHA from a source that is not refined and put into a bottle: such as eating actual algae — e.g. ground up, or dried. I will return to this when I’ve had a chance to do some research on my own…..

  12. My wife is pregnant and we both are questioning why so many women are not doing natural births anymore and are instead receiving a shot to take away the pain, or doing a C-section? And also why is labor so long for a lot of women? We both feel that there has to be some connection with diet here. Is it because babies are now bigger than normal when they are born because of the mothers diet? Is it because the woman’s body can’t work properly because of diet? We’ve read articles on how our grand parents and great grand parents all did natural births, and the babies were much smaller than they are now, and labor was much shorter than it is now. It would be great to get some of these questions answered if anyone at Nutritionfacts.org knows, or has found studies on this subject. Thank you.

  13. I will soon be trying to get pregnant and I’m seeking advice on a particular problem.

    Last year I got pregnant (March 2015) and at week 21-23, upon extensive investigations (several ultrasounds made by different doctors and an fetal MRI) it was confirmed that the baby had vermian hypoplasia, increased dimensions of the posterior fossa with a Blake’s pouch cyst and too short corpus callosum. (I hope what I translated makes sense). Because of the risks associated with these conditions I decided to terminate the pregnancy.

    Before I found out about the pregnancy, I was:
    – Vegan for 5 years (not whole plant foods, but more of a junk vegan)
    – Smoking 16 years
    – Drinking once (not hammered drunk, but quite a few drinks) in one of the nights after conception (before finding out …)
    – Unknown B12 level (eating fortified b12 foods), not supplementing with B12.
    – 79kg / 165 cm
    – Age 31

    As soon as I found out about the pregnancy (week 5) I:
    – Quit smoking
    – Didn’t have any alcohol
    – Still on a vegan diet I incorporated more whole plants but still ate to oily
    – Ended up at 88 kg at week 24 of pregnancy
    – Tested my B12 levels and they were in graphic, but on the low side.
    – Taking prenatal vitamins
    – All ultrasounds and test taken before week 21 were fine, down screening turned out fine, all blood work was fine

    Before conceiving again I will:
    – Lose weight – eat a whole plants vegan diet
    – Not smoke
    – Not drink alcohol in general, especially not 1 month before
    – Supplement b12 and DHA from algae

    My questions are:
    – How likely is it that I have caused my baby the problems, for the mistakes that I have made?
    – Should I get tested for something in particular? (genetic testing, diseases, mercury?)
    – What else should I do?

    Thank you very much for considering answering my lengthy questions

  14. DHA/EPA as a dipping agent. A pill for health. A benefit of development lost to those of us who are not children. Omega threes are very critical for mental health. Perhaps children could be treated nutritionally for diseases to make them smarter. Perhaps there is a benefit. Perhaps the benefit can be gained. Perhaps health can be gained from food and not drugs.

  15. Hi there,
    Can any one recommend good nutritional guides (or a book to read or website) for vegan pregnant women?
    I have been vegan for years now, and now I am pregnant for the 1st time. And I just want to be sure that I have all the building blocks necessary for a healthy baby. (doct and family not supportive)
    I still need to do a blood test, but in previous years I was always low in Vit D and Iron (although less low than when I was an omnivore) The thing is I have a bunch of allergies, so my intake of lots raw fruits and some raw veggies is fairly limited.
    I do eat lots of cooked veggies, greens, legumes, whole carbs …
    Any suggestion on literature that could be helpful.
    I was reading how not to die (great so far) but as I now know I am pregnant I would like to focus on that.
    Thanks a lot for your help and suggestions! Have a great day!

    1. TLeaf77: There are a couple of good resources for figuring out what to eat when you are pregnant as well as what to feed baby as she/he grows up. I recommend checking out the relevant chapter in the book Becoming Vegan, Express Edition. The authors of the book go into great detail on nutrition for each trimester. Further reading helps you figure out how to meet the needs of babies and children. And later teens. These authors have been spoken highly of by Dr. Greger, have done a guest blog on NutritionFacts, and the Becoming Vegan book is even mentioned in the How Not To Die book. If interested in the book: https://www.amazon.com/Becoming-Vegan-Express-Plant-based-Nutrition/dp/1570672954/ref=sr_1_1_twi_pap_1?s=books&ie=UTF8&qid=1467669258&sr=1-1&keywords=becoming+vegan+express+edition
      .
      Dr. Greger has also spoken highly of the Vegetarian Resource Group. The site has a page for kids, including pregancy. The site is generally well researched, so I feel pretty good recommending people to that site. Here is the general “families” page. Scroll down to the nutrition section for specific nutrition information: http://www.vrg.org/family/kidsindex.htm. Here’s one of the articles on that page: Vegan Nutrition In Pregnancy: http://www.vrg.org/nutrition/veganpregnancy.php
      .
      It can be very hard when we are not getting support from the very people, including our doctors, who should be supporting us–especially when you are making a pro-health decision. If it’s any help, the ADA has made this official statement in a position paper:
      .
      It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases. Well-planned vegetarian diets are appropriate for individuals during all stages of the life cycle, including pregnancy, lactation, infancy, childhood, and adolescence, and for athletes.
      .

      This info may be helpful at some point too:

      http://www.pcrm.org/pdfs/health/info_children.pdf
      http://www.pcrm.org/pdfs/health/info_advchild.pdf
      .
      I hope this helps. Good luck to you.

  16. Dr. Greger,
    i’m not sure if this was already covered but is there any list of supplements you would generally advice a pregnant vegan woman to take?

    Thank you so much,
    Greetings from Germany

  17. Thanks for this interesting video. Very helpful to have the research consolidated like this. I have been trying to find a vegan omega 3 (EPA & DHA) supplement that is safe during pregnancy but all appear to contain Rosemary Extract and or Carrageenan which have both been deemed unsafe to take during pregnancy by various authorities of pregnancy health. Do you know what if any would be a safe level of Rosemary to take during pregnancy? For example there is only about 17mg of rosemary extract in the recommended daily dose for Omega 3 during pregnancy. Would this be safe to take? Do you otherwise know of any brands that make Omega 3 oil based on algae that do not contain Rosemary extract or Carrageenan? Your help would be very much appreciated.

    1. Jamie: I don’t know about the rosemary. I do know that the carrageenan would just be in the shell of the pill. So, you could do what others do and puncture the pill and suck out the oil. Or just bite down till it breaks and suck out the oil. Alternatively, they sell liquid algae based DHA/EPA supplements that do not have the carrageenan. I’m not promoting any one particular brand, but here is an example in case you are wondering what I’m talking about: https://www.amazon.com/Deva-Nutrition-Liquid-Herbal-Supplement/dp/B00AP71E08/ref=sr_1_fkmr2_2_a_it?s=hpc&ie=UTF8&qid=1481262344&sr=8-2-fkmr2&keywords=liquid+algae+dha

  18. Thanks Thea, I actually found a few that don’t have Rosemary extract for those that are pregnant and vegan and may be wanting to take a supplement that doesn’t have Carrageenan or Rosemary extract. In my extensive research over a few days I could only find two brands. One is Bluebonnet DHA (but it’s only DHA) you would need to squeeze out the liquid from the capsules to avoid the Carrageenan and the other is Source Naturals who do an EPA and DHA mix without Rosemary Extract but again they use Carrageenan in the capsules so you would need to squeeze out the liquid. Unfortunately the dosage is quite low so if you want to take a large dose you need to take many in a day. But at least there is an option rather than taking fish products for those that don’t want to support any industry that perpetuates creulty and violence. Thank you Nutrition Facts, I’ll be returning for further help on making nutritional decisions in the future. Much appreciated. I hope others find this information helpful.

  19. Hello,

    I am currently breastfeeding my 9 month old son, but do not plan on breastfeeding past his first birthday. I would like to not supplement with cow’s milk after his first birthday. Is there a better alternative for a mom who wants to raise her child with the whole foods, plant based diet?

  20. Kate,
    Yes, soy milk is a good alternative to cows milk. It has a similar macro-nutrient profile to whole cow’s milk (CHO, Protein, Fat). Feeding your child a balanced WFPB diet will provide tremendously more nutrients than the typical toddlers diet. Please check out some of the videos that specifically address childrens’ health.
    https://nutritionfacts.org/topics/children/. You are wise to avoid dairy considering some of the autoimmune diseases that appear to be linked to dairy consumption.

  21. From a purely nutritional standpoint, is fish oil really that bad? Surely any reputable company filters out heavy metals and such. Any algae supplement I’ve come across either uses carrageenan, is dha only, or really low in dha/epa so to take enough to GET enough, it’s expensive.

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