Message to Palestianian vegans (omega-3s)

Results from what seems to be the first study to assess the omega-3 fatty acids status in individuals living in Palestine (Palestinian Territories) have just been published (Almasri et al. 2023).

The study highlights that the intake of fish and "seafood" (which are a rich source of omega-3 fatty acids) was very low in this region, which is hardly surprising. All participants of the study resided in Hebron (West Bank).

The authors of the study suggest that the so-called "omega-3 index" is a good indicator of good health (if the index is high) or increased health risk (if the index is low). This is currently accepted by many, but I don't find it convincing. The omega-3 index might just be a marker of fish intake (in the general population) and fish intake might be a marker for low meat intake and a generally healthier lifestyle (fish is considered healthy after all).

For the general population, the typical way to increase the omega-3 index would be to eat sea animals (fishes, etc.) or to take a fish oil supplement ... and the equivalent for vegetarians and vegans would be to take a microalgae oil-based EPA/DHA (long-chain omega-3 fatty acids present in sea fish) supplement. However, this type of supplement is probably not all that easily available and/or not very affordable for some vegans and vegetarians in Palestine ... So, some vegans and vegetarians in Palestine might ask themselves if they would maybe benefit from eating fish (instead of being vegetarian/vegan) and if they would be healthier, i.e., if a vegan/vegetarian diet would somehow be less healthy or harmful if one does not take an EPA/DHA supplement.

This is the answer I would give:

Vegan EPA/DHA supplements (or fish oil) are usually recommended for three different reasons:
  • during pregnancy/breastfeeding/early childhood
  • for dementia prevention
  • for heart attack prevention

In the first case (pregnancy/breastfeeding/early childhood), I would recommend taking a vegan EPA/DHA supplement. It might (!) be beneficial for the child's health (brain development, eye health, etc.) [Jiang et al. 2023]. But this is far from certain. And I don't think that it is essential to take this type of supplement (or to give it to your children) [Crozier et al. 2019, Burdge 2019]. EPA/DHA supplements, taken during pregnancy, may decrease the risk of preterm delivery (premature birth) but, again, this isn't certain [Sun et al. 2022Middleton et al. 2018].  

In the second case (prevention of dementia), the evidence is very weak that EPA/DHA supplements can be beneficial [Brainard et al. 2020]. So, I wouldn't recommend such a supplement for that reason.

In the third case (prevention of heart attacks), the evidence is relatively certain that EPA/DHA supplements are not very effective (or possible not effective at all) [Quispe et al. 2022Visseren et al. 2021Nicholls et al. 2020Nissen et al. 2021, Fernández Ruiz 2019]. They might be helpful in people who have already had a heart attack and have high triglyceride blood levels - but usually in this case a high-dose EPA only supplement (without DHA) is recommended. And vegan versions of these are very uncommon (and not high-dose) [Rabbat et al. 2023Ridker et al. 2022Harrington 2022Olshansky et al. 2023Gaba et al. 2022].

So, the solution (take home message) regarding omega-3 fatty acids, I would say, is this:
  • During pregnancy/breastfeeding/early childhood take a vegan EPA/DHA supplement - if you have access to one. Otherwise don't worry too much about it.
  • For dementia prevention, don't bother with an EPA/DHA supplement.
  • For heart attack prevention, don't bother with an EPA/DHA supplement.

But do make sure to consume good sources of the plant-based ("short-chain") omega-3 fatty acid (alpha-linolenic acid = ALA) [Burdge 2022, Sala-Vila et al. 2022]. Your health is important, both for yourself and for "animal liberation".

It is also possible that EPA/DHA supplements may be beneficial in the case of depression but, again, this is uncertain [Reily et al. 2023, Accinni et al. 2022Appleton et al. 2021Deane et al. 2021Suradom et al. 2021Zhang et al. 2020, Mocking et al. 2020, Nasir und Bloch 2019Bai et al. 2018]. Also see this post regarding possible effects of nutrition in the case of depression.

The study mentioned here also indicates that the participants ate very little of the plant-based omega-3 fatty acid (alpha-linolenic acid = ALA), which is not a great idea for long-term health. If you eat plenty of ALA and have a generally healthy diet you can probably get the same benefits to your health as from a generally healthy diet + eating fish.

You don't need to eat fish or other sea animals to be healthy. This isn't all that controversial anymore.

For more detailed info, please check this out: A healthy vegan guide for the Palestinian Territories. It's still up-to-date.

And please share it with your vegetarian and vegan (and flexitarian and wanna-be vegetarian) friends.

In case you have high blood cholesterol levels (some vegetarians and vegans do but most don't), check out: Vegan and high cholesterol ... what now?

And for some official recommendations (heart attack - and dementia - prevention) for vegetarians and vegans check out: The National Lipid Organization's recommendations for cholesterol lowering in vegans.

Related: Vitamin A and vitamin D deficiencies in children in the Palestinian Territories