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Vegetarian Journal Sept/Oct 2001

American Heart Association Calls for Eating Fish Twice Per Week - Whatís a Vegetarian To Do?

by Gail Nelson, MPH, RD

At the Food and Nutrition Conference and Exhibition sponsored last October by the American Dietetic Association, I attended a session where the new American Heart Association (AHA) dietary guidelines for the reduction of heart disease were revealed. As a vegetarian, my diet is usually in line with all the nutrition recommendations and guidelines - eat less fat, saturated fat and cholesterol; consume more fruits, vegetables and grains; maintain a healthy weight. Eating a healthy vegetarian diet usually helps ensure that these guidelines are met. Not in this case, however!

Appearing in the new AHA guidelines is the recommendation to consume fish twice per week. The reason? Certain types of fish are high in omega-3 fatty acids, which can help prevent heart disease. Even though Iíve been a vegetarian for over six years, and have never liked the taste of fish - even in my pre-vegetarian years - I found myself contemplating whether I should add fish to my diet. I quickly decided that no matter how healthy fish may be, I wouldnít be running to the local fish stand twice a week for my omega-3 fix. Instead, I decided to put on my dietitian investigator hat and find out how I could get my omega-3ís from vegetarian food sources. Read on to see what I discovered.

What are Omega-3ís?
To understand what omega-3ís are, it will be helpful to back up for a mini-nutrition lesson on fats. Fats are made up of building blocks called fatty acids. There are three main types of fatty acids: saturated, unsaturated, and monounsaturated. Omega-3 fatty acids are classified as unsaturated.

The three omega-3 fats are: alpha-linolenic acid (ALA), eicosapentanenoic acid (EPA), and docosahexaenoic acid (DHA). ALA is found mostly in plant foods; EPA and DHA are found mostly in fish. Our bodies convert ALA into EPA and DHA: consuming 10 grams of ALA yields roughly one gram of EPA and DHA. This means that those of us who donít eat fish get most of our omega-3ís as alpha-linolenic acid (ALA), which is then converted by our bodies into EPA and DHA.

Omega-6 fatty acids are another type of unsaturated fat. As will be discussed later, Americans in general eat too much omega-6 fat, and not enough omega-3 fat. Most people could benefit from making dietary changes so that theyíre eating more omega-3 and less omega-6 fat.

Our nutrition lesson would not be complete without some words about saturated, monounsaturated, and trans fats. In general, it is best to limit our intake of foods high in saturated fats (animal protein, butter, coconut oil), and increase our intake of foods that contain monounsaturated fats (found in nuts and plant oils such as olive and canola). Trans fats are unsaturated fats that have been altered and transformed into saturated fat ( as in margarine, which is essentially vegetable oil that has been processed to make it harder and more saturated) - these should be limited as well. Keeping in mind that total fat should be limited to no more than 30% of calories, itís best to increase sources of monounsaturated and omega-3 fats, and decrease our intake of saturated, trans, and omega-6 fats.

Whatís This Omega-3 Hype All About?
Recent research has shown that omega-3ís are associated with an array of positive health benefits including protection against heart disease, thrombosis, hypertension, some types of cancer, and inflammatory and autoimmune disorders. Recent studies have also shown that omega 3ís are needed for proper infant growth and development.

What are Some Food Sources of Omega-3ís?
Good vegetarian sources of omega-3ís include flaxseed and flaxseed oil, canola oil, soybean oil, soybeans, walnuts, walnut oil, and purslane. (See table for specific foods and amounts.) If you consume eggs, you might be interested to know that high omega-3 eggs are available in the market - these are produced by chickens fed a high flaxseed diet. The fat in dark green, leafy vegetables is 80% omega-3; but due to the low overall fat content these foods usually donít end up contributing a significant amount of omega-3ís to our diets. As you can see from the table, flaxseed and walnuts are the best sources of omega-3ís.

Are There Any Specific Recommendations for Omega-3ís?
At this time, there is no Recommended Dietary Allowance (RDA) for omega-3ís, however, a group of nutrition scientists has recently given guidelines for individual omega-3ís. They suggest daily intakes as follows: ALA - 2.2 grams per day, and EPA/DHA combined - 0.65 grams per day. Canada and the United Kingdom have also made recommendations. Canada recommends a total omega-3 intake of 1.2-1.6 grams per day. The United Kingdom recommends that 1% of calories be from ALA, and 0.5% of calories be from EPA/DHA combined. For a person who averages 2000 calories per day, this translates into 1 gram of EPA/DHA and 2 grams of ALA per day.

In addition to paying attention to the amount of omega-3ís you eat, itís also important to look at the omega-6 (n6) to omega-3 (n3) ratio of your diet. The World Health Organization (WHO) recommends a n6:n3 ratio of 5-10:1, Sweden recommends a ratio of 5:1, and other groups recommend 2.3:1. The literature suggests that the typical American diet has a n6:n3 ratio of 9.8:1. This means that we consume 9.8 grams of n6 for every one gram of n3. The main sources of omega-6 fatty acids in our diets include corn and safflower oils, and processed foods made with these oils. In order to improve your ratio, you would want to choose cooking oils with a low n6:n3 ratio (see table), and incorporate more high omega-3 foods into your diet. Using cooking oils that are high in monounsaturated fats (ie olive and canola oils) also helps to lower the n6:n3 ratio.

What About Supplements?
Several varieties of omega-3 supplements are available on the market. Although most of these are derived from fish sources, it is possible to find ones that are derived from plant sources - mostly flaxseed - however these are mostly in gelcap form. In general, itís probably not necessary to rely on supplements for omega-3ís, as long as you eat omega-3 -containing foods on a regular basis.

So, Whatís the Bottom Line?
To summarize, there are no official recommendations in the U.S. for vegetarian sources of omega-3ís. However, it does seem prudent to try to include food sources of omega-3ís on a regular basis. This can easily be done be using modest amounts of ground flaxseed, walnuts, and other good sources of omega-3. You can also improve the omega-6: omega-3 ratio of your diet by replacing cooking oils that are high in omega-6 fats with ones that are higher in omega-3ís and monounsaturated fats - ie canola, soybean and olive oils in place of corn oil.

Flax Product Information

Flax Council of Canada
Recipes, flax uses, flax resources

Dimpflmeier Bakery LTD
Linseed Rye, 100% Rye with Linseed

Bobís Red Mill Natural Foods, Inc.
5 Grain Cereal, 7 Grain Cereal, Apple Cinnamon Grains

Health Valley Company
Organic Golden Flax Cereal

Pizzeyís Milling & Baking Company
Flax Ďn Bran Muffin Mix, Canadian Flax Muffin Mix, Flax Pancake & Waffle Mix

Nunweilerís Flour Company
Wheat ní Flax Pancake Mix

Flax Facts

Flaxseed can be purchased whole or ground. It is generally more cost-effective to buy it whole, and grind it yourself. Whole flaxseed can be found in the bulk section of most natural food stores. Grind in a clean coffee bean grinder or blender.

Ground flaxseed can be used to replace eggs and oil in many baked good recipes. To use as an egg substitute: mix 1 Tbsp ground flaxseed with 3 Tbsp water. Beat with a small whisk until frothy. This equals one egg. To use flaxseed as an oil substitute: grind, and then use triple the amount of oil called for in the recipe.

Due to the high oil content, ground flaxseed can become rancid. To avoid this, grind a small amount at a time, and refrigerate leftovers in an airtight, opaque container for up to 30 days. Whole (unground) flaxseed can be stored at room temperature for up to one year.

Flaxseed oil is very perishable, and is sensitive to heat, light, and oxygen. It should not be used for grilling or frying, but can be used in cold foods. Try using it in salad dressings and sauces, and use just a little at a time.

Fun With Flax
First, grind it, thenÖ
Sprinkle a tablespoon onto your morning cereal.
Stir some into your yogurt for a sustaining mid-morning snack.
Toss some into your soup at lunch.
Throw some onto your salad at dinner.
Blend some into a fruit and yogurt smoothie for a post-workout replenisher.

Source of nutrient amounts: The Food Processor Nutrition and Fitness Software, ESHA (except as indicated)

Food Serving Size Omega-3 Content
flaxseed oil 1 Tbsp 7.5 grams
flaxseed* 1 Tbsp 2.8 grams
walnut oil 2 Tbsp 2.8 grams
canola oil 2 Tbsp 2.5 grams
walnut halves 1/4 cup 2.3 grams
soybean oil 2 Tbsp 1.9grams
soybeans 1/2 cup .3 grams
pecans, chpd 1/4 cup .3 grams
tofu 4 oz .3 grams
soy milk 8 oz .2 grams
wheat germ 1/4 cup .2 grams
kale, boiled 1/2 cup .1 grams


Type of Oil Omega-6:Omega-3 Ratio
flaxseed 0.3:1
canola 2:1
walnut 5:1
soybean 7:1
corn 58:1
safflower 365:1


Cranberry Walnut Pita
Makes a quick and tasty lunch!

1 cup mixed greens
2 Tbsp Trader Joeís Reduced Fat Cilantro Salad Dressing*
ľ cup chopped walnut halves
3 Tbsp dried cranberries
1 slice soy cheese
1 pita pocket

Mix the greens, salad dressing, walnuts and cranberries in a medium mixing bowl. Stuff mixture, along with soy cheese, into pita pocket. Makes one serving.

*For those of you who donít have access to a Trader Joeís, any creamy garden-flavor salad dressing (preferably a low-fat variety) will do.

Omega-3 Fruit Salad
This goes well as a side dish with lunch or dinner, and also makes an excellent, filling snack.

1 apple, peeled, cored, and cut into chunks
1 orange, peeled and cut into chunks
1 banana, peeled and sliced
1 Tbsp lemon juice
Ĺ cup plain or vanilla yogurt (soy or regular)
ľ cup chopped walnuts
3 Tbsp ground flaxseed

Prepare the fruit, and toss with lemon juice. Mix in the yogurt, walnuts, and flaxseed. Makes three servings.

Danís Favorite Burger
These go well served on a bun with all the fixinís. I like to serve with baked sweet potato fries on the side.

3 cups black beans, canned or cooked
ľ cup ground flaxseed
ľ cup chopped walnuts
Ĺ cup grated carrots
1 Tbsp soy sauce
1 Tbsp water
ľ tsp salt
1 tsp basil
1 tsp onion powder
Ĺ tsp black pepper
Ĺ tsp red pepper
1 tsp oregano

If using dried beans, cook according to directions. Mash beans. Add the remaining ingredients and mix well. If mixture seems too dry, add additional water to moisten. If mixture seems to wet, add, additional flaxseed. Form mixture into patties. Spray skillet with nonstick spray and preheat on stovetop. Place patties on skillet. Cook for five minutes, then turn and cook other side five minutes.

Trail Mix
This is a great midday snack; also good for the trails.

1/2 cup dried pineapple
1/2 cup dried papaya
1/2 cup chopped walnuts
1/4 cup carob chips

Mix together. Makes 7 servings (1/4 cup each).

Oatmeal Surprise
This is a quick and easy breakfast that will give you energy all morning long.

1 cup oatmeal, uncooked
1-3/4 cups water, rice milk or soy milk
2 Tbsp ground flaxseed
2 Tbsp chopped walnuts
2 Tbsp maple syrup
2 Tbsp raisins

Cook oatmeal with water or milk according to directions. Mix in remaining ingredients.

Peanut Butter and Flax Oatmeal Cookies
Cookies that are good for you, and taste good too!

ĺ cup peanut butter (smooth or chunky)
ĺ cup maple syrup
ĺ cup sugar
ľ cup plus 3 Tbsp soy milk
Ĺ cup plus 1 Tbsp ground flax seed
2 tsp vanilla
3 cups quick or old-fashioned oatmeal, uncooked
1-3/4 cups whole wheat flour
1 tsp baking soda
1 cup raisins

In a large bowl, beat peanut butter, syrup and sugar with an electric mixer until creamy. Add ground flax seed, soy milk, and vanilla; mix well. In a separate bowl, combine oatmeal, flour, and baking soda, and mix well. Add to the peanut butter mixture, and mix well. Stir in raisins. Cover and chill at least 30 minutes. Heat oven to 375 degrees. Drop rounded tablespoons of dough onto ungreased cookie sheets. Bake 7 to 9 minutes or until light golden brown. Remove to a wire rack and cool completely. Store covered and refrigerated.

Excerpts from the Sept/Oct 2001 Issue

The Vegetarian Journal published here is not the complete issue, but these are excerpts from the published magazine. Anyone wanting to see everything should subscribe to the magazine.

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August 17, 2001

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