Who doesn't love dessert for breakfast? Last weekend I made a peaches and cream version of this parfait, but I felt something was missing...Chocolate! This chocolate and cherry version looks and tastes decadent but, because I used only whole food ingredients, won't leave you feeling weighed down. With chia seeds and fruit, this breakfast is a good source of healthy Omega 3 fats and fiber.
Chia seeds are actually tiny nutritional powerhouses that are packed with Omega 3's, among other nutrients. After reading some posts online (read Facebook), I decided to do a bit of research into Omega 3's and how they relate to our risk of developing heart disease risk and dementia, especially given that they tend to be low in the vegan diet. If you're interested in finding out what omega 3's are, why they matter and how to eat more of them, read on after the photo! Otherwise, go to the recipe.
OMEGA-3 Fatty Acids in the Vegan or Plant-based diet.
This article can get a little technical at points, if you want the shortened version, read through the "Key Points" at the end of each section. I've linked my references as well as some interesting links throughout the piece.
What are Omega-3 Fatty Acids?
Omega 3 fatty acids are specific type of polyunsaturated fatty acid (PUFA) where the first double bond, or point of desaturation, occurs between the third and fourth carbon atom. There is a good diagram in this article, for those of you who are interested. Examples of omega-3 fatty acids (FA) include alpha-linolenic acid (ALA 18:3), eicosapentaenoic acid (EPA 20:5) and docasahexaenoic acid (22:6). The 18:3 notation means that the fatty acid is 18 carbons long with three double bonds, making it polyunsaturated. Omega-3s are one of two types of PUFAs, the other being Omega-6, that along with mono-unsaturated fatty acids (MUFAs) are considered healthy fats. Healthy fats have been shown by some studies to reduce total cholesterol and LDL, elevation of which are a risk factors for heart disease, when used to replace the saturated and especially trans fat in our diets(1)(2).
Essential Fatty Acids:
Omega 3 Fatty acids are what’s known as “essential fatty acids". As such, they cannot be synthesized by our cells; we need a dietary source in order to make them. ALA acts as a building block for EPA and DHA, though the rates of conversion are low, with one study finding them to be only 6% and 3.8%(3) respectively. Both EPA and DHA are important components of cellular membranes. DHA in particular is important for cognitive, retinal and testicular function, including sperm production(4). EPA and DHA can be obtained from food sources; cold water fish, such as salmon, provide a relatively high amount of these fatty acids and algae provides relatively small amounts. However, vegans and vegetarians, especially those over age 60, tend to be low in these essential fatty acids(5), due to low dietary intake and low conversion rates. Of note, these low levels have not yet been linked to increased incidence of disease in the long term, but many experts (such as this vegan RD) recommend targeted dietary intake or supplementation in order to replicate more typical levels(
Another note of interest is that the actual ratio of omega-3 to omega-6 in your diet can cause an apparent deficiency. This happens because the pathway to make longer chain omega-3 fatty acids is the same pathway used to make the longer omega-6 fatty acids. Basically, if the pathway becomes jammed up with omega-6 fatty acids, omega-3 synthesis is essentially blocked and EPA and DHA won't be made. The optimal omega-6 to omega-3 ratio is an ongoing source of debate, that I'm not going to go into here, but a ratio of somewhere less then 4-6 allows for adequate omega-3 metabolism(3). For vegetarians and vegans, this is not as much of a concern, as most omega-6 fatty acids come from animal sources, though high amounts are found in grape seed oil, tropical oils (such as coconut or palm oil), corn oil, sunflower oil and soy oil. Omega-6 FA are also important for a variety of body functions, and should not be avoided, but increasing your omega-3 intake at watching out for excessive omega-6 intake can ensure you get enough of both.
- Omega-3s are important for a variety of cellular functions and support the healthy functioning of cells in the brain, retina and testicles. Types of Omega-3 include ALA, EHA and DPA.
- ALA is found in a variety of foods: plant sources include soy, chia seeds, flax seeds, walnuts, pecans, canola oil and kiwi.
- EPA is found mostly in cold-water fish, such as salmon, and in very small amounts in algae.
- DHA is found in cold-water fish, such as salmon. There are small amounts available in algae.
- ALA can be converted to EPA and then DHA by the body, though the rate of conversion is slow. A diet excessive in omega-6 can further slow down this process, meaning the intake of omega-6 and omega-3 need to be balanced.
- Vegans are at risk of omega 3 deficiencies as their diet tends not to be adequate in ALA.
Why are they important?
DHA and EPA are an important component of cell membranes throughout the body and are found abundantly in brain, retinal and testicular tissues. They are particularly important in young children for brain and eye development. More recently, PUFAs, and particularly omega-3s have been examined in the context of preventing heart disease and dementia. In the light of some recent evidence, I'm going to go into these two in a bit more detail.
In 2002, the American Heart Association (AHA) released a report based on epidemiological studies recommending a diet high in omega-3s via regular fatty fish consumption as a way of preventing sudden cardiac death(6). Their recommendations were rapidly adopted by many dietary associations, however, the exact degree and mechanism of benefits of fish and fish oil in cardiac prevention are still being worked out.
The original 2002 recommendation was mostly based on epidemiological studies, which I will summarize briefly:
- Epidemiological studies were divided between a positive effect and no effect for fish intake on death rates from coronary heart disease (CHD) and myocardial infarction(MI)(6).
- Two epidemiological studies showed that rates of sudden cardiac death were approximately halved with 1-2 weekly fish portions: the US Physicians Health Study(7) and a case control study(8). The case-control study looked at cases of sudden cardiac death and compared their omega-3 levels to that of the general population. However, the cases had significant differences in other risk factors for heart disease (such as diabetes and weight) relative to the general population, which makes it impossible to say what, if any, effect fish consumption alone had in this study.
- For ALA, three epidemiological studies, using data from the Health Professionals Study(9), the National Heart, Lung, and Blood Institute Family Heart Study(10) and the Nurses' Healthy study(11), found reduced risk of acute MI, fatal MI and coronary artery disease, respectively. It should be noted that the Health Professionals study found no effect on death and that the results for heart attack only became significant after adjustment for fiber intake, other fat intake (no effect saturated effect, greater protective effect in concert with omega-6) and lifestyle factors(9). This suggests that though ALA may confer some protective benefit, the whole diet is likely more important then ALA consumption in isolation.
- Randomized controlled trials(RCTs) for ALA consumption have only been completed in individuals with a history of cardiac disease. 1 trial was positive for reduction in non-fatal cardiac events but saw no difference in mortality(12). The other two trials found no difference(13)(14). The only positive RCTs in terms of reducing risk of repeat MI and cardiac death that involve increased ALA come from trials in post-MI patients where the entire diet was totally changed to a Meditterean style diet(15), which again suggests that the entire dietary picture is the most important factor for cardiac health.
- In this iteration, 3 RCTs supported the use of omega-3 supplements, in the form of fish oil, for reducing mortality for individuals who had already had a cardiac event(6).
In the more recent 2017 AHA guidelines (16) RCTs looking at fish oil supplements in the prevention of cardiovascular disease, heart failure and stroke in patients with a previous history of cardiac disease or a history of cardiac risk factors, like diabetes, were examined. No RCTs to date have looked at fish oil supplementation in healthy individuals, though one is in progress. They concluded that there may be some benefit in supplementing omega-3 fatty acids in patients with known CHD, as a composite analysis of the included trials found reduced mortality (17), though not necessarily a reduced rate of recurrent heart attack. Interestingly, the three most recent RCTs, which came out after the 2002 publication, were all negative for the use of omega-3s in this patient group. The AHA hypothesized this may have been due to increased awareness of omega-3 benefits, better disease management and the size of the trials being too small to detect the effect. You can find a useful summary of their results here. Taken all together, suffice it to say that the use of omega-3's in this group is still up for debate, but given the low harm associated with dietary supplementation (fish excluded), the recommendation still stands.
This all being said, meta-analysis has shown that a vegan diet reduces risk of ischemic heart disease by 26%, an effect which may actually be higher in men, according to the Adventists Healthy Study. So, despite their low dietary EPA and DHA, vegans are likely to receive some heart protection from diet above that of the general population(18)(19).
Omega 3’s are an important component of the cell membranes of the neurons found in your brain. DHA in particular is important for brain development and function(20), and because people with Alzheimer’s Disease (AD) have been found to have lower concentrations of DHA in their cell membranes, it has been postulated that low DHA levels may contribute to cognitive decline, a hypothesis that initially also seemed supported by epidemiological studies. However, a 2017 RCT which examined the effect of omega-3 supplementation on cognitive decline in older patients presenting with memory complaints found no effect for intervention with omega-3 supplementation(21), a conclusion supported by meta-analysis' by two groups which found no benefit in omega-3 supplementation in either the treatment(22) or prevention of AD(23)though there may exist a small benefit in early stages of cognitive decline.
- Though omega-3s are an important component of cellular membranes and are important for normal brain, eye and testicular function, recent evidence suggests that their "wonder fat" status may be a little overstated.
- The AHA continues to recommend Omega-3s supplementation as an intervention that may be helpful in preventing mortality in people with pre-existing heart disease.
- Epidemiological studies (poor evidence) suggest that high levels of omega-3 in the diet are associated with a reduced likelihood of sudden cardiac death and may (mixed positive and negative trials) be cardioprotective.
- Whole foods diets with an emphasis on plant protein that replace trans and saturated fat with unsaturated fats, including omega-3s, do seem to reduce risk of cardiac events and mortality.
- Omega 3's do not seem to be useful in treating Alzheimer's disease, though they may help with early or mild cognitive decline.
So, from all of this I think it is safe to conclude that eating a diet high in fruits and vegetables and replacing trans and saturated fat with mono and polyunsaturated fats does promote heart health, though the benefits of particular types of unsaturated fats is less clear. As vegans and vegetarians tend to be low, they should focus on obtaining plant-based sources of omega-3.
So How Much Omega-3 do I Actually Need?
|Men >19||1.6 g/day|
|Women > 19||1.1 g/day|
*note: no upper limit has been established. This is based off the Canadian dietetics association guideline(24). You can find more details about omega-3 requirements for pregnant and lactating women as well as other food sources on their website. Children, especially young children will have higher requirements. People with diabetes or heart disease should talk to their doctor.
What are good sources of Omega-3 in the vegan diet?
- Flaxseeds (ground): 1.6g/Tbsp
- Flaxseed oil: 2.5g/tsp
- Chia seed(2 Tbsp = 1oz): 5g/oz
- English walnuts (typical): 2.6g/oz
So for a vegan or vegetarian, adding a Tbsp of ground flaxseed or chia seed to your daily oatmeal or smoothy should cover your omega-3 requirements.
As I previously mentioned, Omega 3 metabolism is reduced in the presence of Omega 6. You can help to balance your intake by watching you consumption of the following oils: corn, soy, safflower, sunflower, most vegetable oil blends (typically labeled "vegetable oil") and sesame oil.
If you are interested in supplementing your omega 3 intake, which I don't do personally for the reasons above, or learning more about omega 3’s there is a good resource by a vegan RD here.
So what did I find? First, though omega-3's are important for the maintenance of normal general bodily functions, and should be included in a healthy diet, they may not be as relevant for the prevention of cardiac events as I initially thought. Second, vegan diets do tend to be low in them, meaning that vegans should take extra care to make sure that they are including daily sources of omega-3 in their diet and that they are achieving a good balance between omega-3 and omega-6. I was honestly pretty surprised by the change in the balance of the available body of evidence over the past couple of years! When I set out to write this, I fully thought I would be writing about all the amazing health benefits of omega-3s and urging everyone to rush out and buy some flax or chia seeds, but what I ended up finding was that the literature has changed a lot since I last went through it, and that extra supplementation isn't really indicated except for in very specific groups. Do I think we should change current recommendations? I would say that in terms of cardiac prevention, the evidence still favours replacing trans and saturated fats with unsaturated fats in the context of a whole foods diet focused on the consumption of fruits, vegetables, unrefined grains and plant-based protein sources. I hope this encourages you to think about your omega-3 intake, whether you're vegan or veggie curious, and whether you are getting enough!
*Please note that this article is purely intended to be educational and is in no way meant to substitute for recommendations from a physician or other health professional.
Luscious chocolate chia pudding complements a sweet cherry puree. All topped with a soft-serve like chocolately banana nice cream.
- 2/3 c unsweetened almond milk (or use sweetened vanilla and omit the sweetener and vanilla)
- 2 Tbsp chia seeds
- 1 Tbsp maple syrup (or other sweetener of choice, I sometimes sweeten with protein powder)
- 1.5-2 Tbsp cocoa powder
- 1/4 tsp salt
- 1 tsp pure vanilla extract
- 1 c. frozen cherries
- 1/2 frozen banana
- 1/2 c almond milk (sweetened or unsweetened)
- 2 frozen ripe bananas*
- 1 tsp pure vanilla
- 2 Tbsp cocoa powder
- 2 Tbsp of chocolate chunks (optional)
- 1 Tbsp chopped dark chocolate
- 1 Tbsp walnut chunks
The night before: peel 3 ripe bananas, break into 5 or 6 pieces and place in the freezer in a ziplock bag. Mix the ingredients for the chocolate chia pudding and place in a container in the fridge to thicken overnight. You may wish to blend the ingredients for a smoother pudding.
The morning of: remove the chocolate chia pudding from the freezer. Make the cherry smoothy using the food processor.
If making two portions, add half of the chia pudding into each glass, layering half of the cherry smoothy on top. Add extra fruit, if desired.
Next, make the banana nice cream by adding two bananas to your food processor. Add the salt, vanilla and cocoa and process until creamy and smooth. You may have to scrape down the sides once or twice as you go. It should have the texture of soft serve ice cream.
Add the icecream to the top of your chia puddings. Garnish with chocolate and walnut pieces, if desired.
*Peel and break ripe bananas into 5-6 pieces before freezing. Freeze at least overnight. Make sure bananas are very ripe, borderline banana bread ripe, otherwise your nice-cream will taste..bad.