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Omega-3 fatty acids for ADHD: Do they work?

by Jack Maypole, MD
Contributor
Wednesday Jan 19, 2011
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"Are omega-3 fatty acids," a savvy parent asked me the other day, "an effective alternative to medications for ADHD?"

Let’s get this out of the way: ’Fatty acid’ sounds like the name of a lousy rock band. No matter. The so-called ’essential fatty acids’ are materials that must be consumed by humans in our diet (we can’t make our own) to keep our nerves healthy and our cell membranes happy. EPA and DHA (known as eicosapentaenoic acid and docosahexaenoic acid, respectively) are the most desirable omega-3 fatty acids. The more we learn, the more we like them. They are good for people.

For example, research has shown the omega-3 fatty acids exert a positive effect on the inflammation and blood circulation in the body. Studies show they reduce risk factors for heart disease, including high cholesterol and high blood pressure. Research suggests omega-3s can help with mental disorders, such as schizophrenia and depression.

In children, the omega-3 fatty acids, EPA and DHA, are known to assist in nerve function and formation.

Research has demonstrated that children with ADHD have lower levels of omega-3s in their bodies compared to their peers. Emerging research has already been done on school-age children to see if giving supplements omega-3 ’deficient’ children makes a difference. An oft-quoted study (among others) of children, ages eight to 12 years old given DHA and EPA supplement improved their academic performance and focus. I am not aware of a study that has yet revealed that giving a child omega-3 fatty acid supplements for ADHD are as or more effective than stimulant medications. For the time being, omega-3 supplementation hasn’t become a mainstay of therapy for ADHD. Yet.
So for the family that is medication-wary, or complementary/alternative therapy inclined, we return to our initial question: Is the use of a omega-3 fatty acid supplement in a child or teen’s diet a safe and effective alternative to taking stimulant medications and their ilk for ADHD?

For seafood lovers, eating certain fish twice a week has been recommended as a healthy, holistic approach for taking omega-3 rich fish oils. For vegetarians, or those with a distaste or allergy to seafood, emphasizing a diet rich in plant sources of ALA (from which EPA and DHA can be made by the body) may be another option. Flaxseed has the highest concentration of ALA, and its oil can be used in making foods or used in salad dressing.

In terms of using omega-3 dietary supplements, such as gels or capsules, there are a few issues to consider. Generally, preparations over the last decade have lessened the tendency for fish oil supplements to have a fishy taste, or to provide unhappy after-burps. And, speaking from experience, some of the flaxseed preparations don’t taste so hot either. Dr Kathi Kemper, on her excellent website at Wake Forest University, suggests that chilling supplements lessens their tendency to have a strong flavor.

In addition, dietary supplements like omega-3s have the potential of any herb or dietary supplement to exert truly pharmacologic effects upon the body. Specifically, omega-3s have a mild blood thinning effect and can interact with medications that do the same, such as aspirin, ibuprofen or other anticoagulant meds.

In terms of buying herbs and supplements, it is a buyer beware scenario. Put simply, the quality control over these products is not as scrupulously followed by the FDA as are the manufacture and sale of pharmaceuticals. So, are these supplements safe? Yes, if chosen well. Caveat emptor.

Dr. Kemper’s website provides us for a reliable guideline for well-established products to choose, and how much omega-3 to give children. Ideally, omega-3 supplements for kids should contain a combination of EPA and DHA. Typical doses are for the COMBINATION of EPA+DHA: 500 mg for six to 12 year olds; 1000-3000 for teens and adults

Bottom-line then, omega-3s are safe and dosing guidelines are now a bit clearer. However, are omega-3 fatty acids given via diet or via omega-3 capsules an effective alternative to stimulant medications?

No, not really. Omega-3 use for children with ADHD has a better role, in my view, as an adjunctive therapy, not as alternative to stimulant medications. I will recommend parents give DHA and EPA preparations to children to complement a broader treatment plan, including behavioral management, other potentially helpful integrative/lifestyles therapies (biofeedback, as one example) and medications, including Ritalin and others. If people use omega-3s supplements with their children, let your primary care doc know. It matters, they might help, and we all may learn something. These omega-3s may have other salutary effects as well.

Food for thought, eh?

Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at www.thefastertimes.com/pediatrics.

Jack Maypole, MD is director of Pediatrics at the South End Community Health Center, and Director of the Comprehensive Care Program at Boston Medical Center, a clinic for children with complex and chronic illness. Portions of his articles are drawn from his blog found at thefastertimes.com/pediatrics.

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