EPA and DHA for ADHD
What is ADHD?
ADHD stands for Attention Deficit/Hyperactivity disorder. It is the most common neurological condition in children and it is becoming more prevalent1. ADHD is a cluster of symptoms that fall into three main categories: inattention, hyperactivity and impulsivity. It is usually diagnosed in childhood and can continue through adolescence and adulthood. Some children affected may be hyperactive, have more trouble being patient or be more impulsive with their behaviour than other children their age. What this means is that a child with ADHD can have more difficulty doing well in school or integrating in their community2. Approximately 3-7% of children in Canada are affected by ADHD, though the percentage is increasing. In a classroom of 25-30 children, at least one is likely affected3. There is no clear causation pathway to the development of ADHD. The causal factors are likely a combination of genetic and environmental factors as ADHD tends to run in families and also follows environmental distribution patterns.
When a disorder is said to be genetically determined, it is often thought there is nothing one can do to address it because genetic information is fixed at birth. However, there is much we can do with our lifestyles that does in fact make a large impact on the expression of the genetic material we inherit. In other words, things we do during our lives (ie diet, substance use, exercise, exposure to chemicals, etc) can modify the way our DNA behaves.
Due to this reason, as well as the fact that ADHD is also affected by environmental factors, there is great opportunity for the treatment of this disorder 1,4.
What are Omega 3 fatty acids/oils?
Omega 3 oils are a specific kind of fat that is present in our cell membranes. They are essential because we are not able to make them ourselves, we must obtain them from our diet. Foods high in Omega-3 include fish, vegetable oils, nuts (especially walnuts), flax seeds, flaxseed oil, and leafy vegetables. Not only is Omega 3 an important part of our cell membranes, they also play a role in the cell signaling between cells, they are the building blocks for blood clotting factors and they affect the contraction and relaxation of blood vessel walls. These are the direct effects of Omega 3 fats, but they also have indirect effects through their binding to receptors that regulate gene function, thereby modifying gene expression of our DNA. These are the cellular-level effects of Omega 3 fats. But what does supplementing with the oils do for our overall health? Omega 3 fats have been shown to:
- prevent heart disease and stroke5
- treat depression and other mood disorders6
- prevent and mediate the progress of type 2 diabetes7, 8
- improve memory and cognitive function9
- reduce inflammation10
Omega 3 fats make a difference in our health. It is helpful to have a good dietary intake, but the benefits and preventive effect of Omega 3 fat is maximized when supplemented above our dietary intake, with dosage according to the presenting concern. There are a few types of Omega 3 fatty acids, with the two most well-known and celebrated being eicosapentaenoic acid (EPA) and docosahexaenoic (DHA). EPA and DHA are mostly found in fish and are often commercially called ‘fish oils’.
Omega 3 supplementation and ADHD
Two facts point to the impact that Omega 3 supplementation may have on ADHD:
- Omega 3 supplementation is effective in other neurological disorders such as cognitive decline, poor memory and depression6,9
- Children with ADHD have altered fatty acid profiles when compared to unaffected children, suggesting a correlation between poor fatty acid profiles and development of the condition. In other words, children with ADHD have a lower proportion of EPA and DHA in their cell membranes than other children. As such, investigators have begun to look at the use of EPA and DHA on children with attention deficit/hyperactivity disorder1
In a recent study with high-dose DHA and EPA supplements given to children with ADHD for 8 weeks, there was significant improvement in the biological and psychosocial markers of the condition. The study measured both the fatty acid content of their cell membranes (as a biological marker) and child behaviour (as a psychosocial marker). The starting dose was 30 g/d of combined EPA and DHA and this was adjusted mid-way through the intervention (week 4) based on the changes occurring in the fatty acid profiles.
Fatty acid profiles: the average EPA and DHA levels in the cell membranes of the supplemented children significantly increased by a factor of 9.5 and 2.4 respectively, meaning that their fatty acid profiles responded to the supplementation. With just 8 weeks of intervention their profiles were significantly changed. This allows us to see, biologically, that the supplementation is having an effect at the cellular level and reaching its goal of improving fatty acid profiles.
Behaviour: All categories of the behavioural scale used (ADHD SC-4) were improved by week 8, specifically inattention, hyperactivity, oppositional/defiant behaviour, cognitive problems/inattention and conduct disorder. This allows us to appreciate the psychosocial impact of supplementation.
What does this mean? It means that supplementation with Omega 3 oils at the correct dose has significant impact on the altered biology and behaviors exhibited in ADHD. It also gives us an understanding of how to track the biological impact of the supplementation, allowing us to study correlations between fatty acid profiles and ADHD presentation1. In short, we can observe the clinical benefit of supplementation at not just a cellular level, but at a ‘life’ level too.
What can you do?
Addressing ADHD in children requires a multi-factorial approach. There is much we can do with lifestyle to modify our genes and therefore modify expression of some conditions. It is an important discovery that supplementing children who have ADHD with high-dose EPA and DHA is a safe and effective way to treat their condition.
How do you take action with this new knowledge to help your children? Talk to your health care provider. Omega 3 supplementation is generally safe, but using it at high doses for medical intervention means it must be monitored. Note that excessive unregulated supplementation affects blood clotting and could dangerously increase bleeding time. Using Omega 3 supplements is an effective way to address ADHD, but proper supplementation dosages and protocol is determined by working with your health care professional/Naturopathic doctor.
- Sorgi et. al., 2007. Effects of an open-label pilot study with high-dose EPA/DHA concentrates on plasma phospholipids and behavior in children with attention deficit hyperactivity disorder. Nutrition Journal 2007. 6. 16. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1971271/.
- NIH, National Institute of Mental Health, Attention Deficit Hyperactivity Disorder. http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder-easy-to-read/index.shtml
- Mental Health Canada, http://www.mentalhealthcanada.com/ConditionsandDisordersDetail.asp?lang%20=e&category=60
- Burgess et. al., Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. American Journal of Clinical Nutrition.2000 Jan;71(1 Suppl):327S-30S. http://www.ncbi.nlm.nih.gov/pubmed/10617991
- Harvard School of Public Health, Omega-3 Fatty Acids: An Essential Contribution http://www.hsph.harvard.edu/nutritionsource/omega-3-fats/
- Mocking et. al., Meta-analysis and meta-regression of omega-3 polyunsaturated fatty acid supplementation for major depressive disorder. Transl Psychiatry.2016 Mar 15;6:e756. doi: 10.1038/tp.2016.29. http://www.ncbi.nlm.nih.gov/pubmed/26978738
- Kim et. al., Intake of fish and long-chainomega-3 polyunsaturated fatty acids and incidence of metabolic syndrome among American young adults: a 25-year follow-up study. European Journal of Nutrition. 2016 Jan 27 http://www.ncbi.nlm.nih.gov/pubmed/26816031
- Tørris et. al., Fish consumption and its possible preventive role on the development and prevalence of metabolic syndrome – a systematic review. Diabetol Metab Syndr.2014 Oct 17;6(1):112. doi: 10.1186/1758-5996-6-112. eCollection 2014. http://www.ncbi.nlm.nih.gov/pubmed/25352919
- Külzow et. al., Impact of Omega-3 Fatty Acid Supplementation on Memory Functions in Healthy Older Adults. Journal of Alzheimers Disease.2016 Feb 10;51(3):713-25. doi: 10.3233/JAD-150886. http://www.ncbi.nlm.nih.gov/pubmed/26890759
- Siriwardhana et. al., Health benefits of n-3 polyunsaturatedfatty acids: eicosapentaenoic acid and docosahexaenoic acid.Adv Food Nutr Res. 2012;65:211-22. doi: 10.1016/B978-0-12-416003-3.00013-5 http://www.ncbi.nlm.nih.gov/pubmed/22361189