Attention deficit hyperactivity disorder (ADHD) - an omega-3
deficiency?
GUELPH, ONTARIO, CANADA. The development of an assay for EPA and DHA in red blood cell fatty acids has
made possible a number of interesting studies from sudden cardiac death to ADHD. In a just published study from
the University of Guelph in Ontario, researchers examined the association between both dietary intake and red
blood cell fatty acid status in a group of adolescents diagnosed with ADHD as compared to an age-matched control
group. Both groups had similar anthropometric measurements such as weight, height, % fat mass, etc. Both groups
consumed equivalent amounts of omega-3 and omega-6 fatty acids but the ADHD group consumed more energy
and fat even though they had similar anthropometry. The ADHD children had significantly lower red blood cell levels
of DHA and total omega-3 fatty acids, higher omega-6 fatty acids and a lower omega-3 to omega-6 ratio. In
addition, this lower omega-3 status correlated with scores obtained with a standard behaviour measurement scale
(the Conners' Parent Rating Scale or CPRS). The authors point out that these abnormal fatty acid profiles are also
observed in younger ADHD children and again are distinctly different from controls of a similar age. Given that the
dietary intakes in this study were similar, the results suggest that there are metabolic differences in fatty acid
handling between ADHD adolescents and normal controls. Finally, they provide evidence from other studies that it
may be possible to improve behaviour patterns with omega-3 supplements, but the successful studies have used
rather large doses (up to 16 g fish oil per day).
Colter, AL, et al. Fatty acid status and behavioural symptoms of Attention Deficit Hyperactivity Disorder in
adolescents: A case-control study. Nutrition Journal, Vol. 7, No. 1, February 14, 2008, p. 8
www.nutritionj.com/content/7/1/8
Fish oil supplementation for ADHD
MILAN, ITALY. Attention-deficit hyperactivity disorder (ADHD) is a growing problem among adolescents in the
western world. Estimates of prevalence vary between 5 and 10% with most victims being boys. The major
symptoms of the disorder are difficulty in sustaining attention, hyperactivity, and impulsivity. There is considerable
evidence that ADHD is linked to a fatty acid deficiency and imbalance, specifically a lack of the omega-3 long chain
fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), and an excess of the omega-6 fatty
acid, arachidonic acid (AA). Clinicians at the University of Milan now report that supplementation with fish oils is
effective in correcting the fatty acid imbalance and improves the symptoms of ADHD.
Their study involved 16 adolescents between the ages of 3.5 and 16 years who had been diagnosed with ADHD.
The study participants received a fish oil supplement for 8 weeks. The fish oil was given at a dose of 250
mg/day/kg bodyweight and contained at least 75% of long chain omega-3 fatty acids with a ratio of EPA to DHA of
2:1. The supplement also contained vitamin E to prevent oxidation of the fatty acids. The average fish oil dosage
was 8.5 grams/day.
The researchers measured the AA:EPA ratio in the blood and red blood cells before and after supplementation, and
parents evaluated inattention and hyperactivity before and after using the Conner's scale. Before supplementation,
the average AA:EPA ratio was 41 as compared to 28 in a group of matched children without ADHD. At the end of
the 8-week study period, the ratio had dropped to 4.1. The average inattention score before supplementation was
19 and the hyperactivity score was 20. These values dropped to 13.9 and 15.5 after supplementation indicating a
significant improvement.
The Italian researchers speculate that ADHD involves a modification to cell membrane fluidity and architecture
caused by an unfavorable AA:EPA ratio, and conclude that fish oil supplementation helps correct this. They also
suggest that an elevated AA:EPA ratio may serve as a marker for ADHD.
Germano, M, et al. Plasma, red blood cells phospholipids and clinical evaluation after long chain omega-3
supplementation in children with attention deficit hyperactivity disorder (ADHD). Nutritional Neuroscience, Vol.
10, February/April 2007, pp. 1-9
Fish oils help ADHD patients
SUDBURY, MASSACHUSETTS. Attention-deficit hyperactivity disorder (ADHD) manifests itself by the inability to
concentrate in a sustained manner, control impulsive actions, and pay attention to tasks. Hyperactivity and
oppositional/defiant behavior are other symptoms of ADHD, which affects as many as 7% of children in the United
States, mostly boys. About 70% if children with ADHD continue to experience ADHD-related problems as adults.
Several clinical studies have noted that ADHD patients have a deficiency of omega-3 long chain fatty acids,
specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the main components of fish oil. It is
also clear that ADHD patients have a very high ratio of arachidonic acid (AA) to EPA.
Depression often accompanies ADHD and an increased AA:EPA ratio correlates positively with severity of
depression. The prevalence of depression is very low in Japan and so is the average AA:EPA ratio which ranges
from about 1.3 to 3. In comparison, US boys with ADHD usually have AA:EPA ratios of 30 or higher. Researchers
at the Inflammation Research Foundation and the Hallowell Center reasoned that it might be possible to reduce
ADHD symptoms by fish oil supplementation using dosages sufficient to bring the AA:EPA ratio down to the
Japanese level and carried out a pilot study to investigate this possibility.
The study involved 6 boys and 3 girls who had been diagnosed with ADHD and were under the care of a
psychiatrist. The median AA:EPA ratio in isolated plasma phospholipids was 20 at the start of the study. All study
participants were instructed to take 2 tablespoons (30 mL) of a liquid concentrate of EPA and DHA supplying a total
of 10.8 grams EPA and 5.4 grams of DHA a day. After 4 weeks, the AA:EPA ratio was measured again and the
EPA+DHA dosage adjusted to ensure an AA:EPA ratio of no less than about 1.5. At the end of the 8-week trial the
median AA:EPA ratio was 1.7 as compared to 20 at baseline. Also over the 8-week period, EPA concentration in
phospholipids increased by a factor of 10, while DHA concentration tripled. AA concentration did not change
significantly. Commensurate with the decrease in AA:EPA ratio, a highly significant reduction in ADHD symptoms
was observed by both the psychiatrist and parents. Inattention score fell from 18 to 10, hyperactivity score from 11
to 5, oppositional/defiant score from 10 to 5, and conduct disorder score from 5 to 1. The researchers conclude that
high-dose EPA+DHA supplementation is effective in reducing the AA:EPA ratio, and markedly reduces the most
common symptoms of ADHD.
Sorgi, PJ, et al. 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, Vol. 6, 2007,
pp. 16-23
Fish oil supplement better than Ritalin
ADELAIDE, AUSTRALIA. Attention-deficit hyperactivity disorder (ADHD) is a rapidly growing problem in the Western world. It is estimated that 5-10% of school-age children (mostly boys) in Europe suffer from the disorder. Comparative figures for the USA and Australia are 3-7% and 11%. Major symptoms of the disorder are difficulty in sustaining attention, hyperactivity, and impulsivity. ADHD is also associated with learning difficulties in reading, spelling, and math and may involve psychiatric problems that follow the child into adulthood. There is considerable evidence that ADHD is linked to a fatty acid deficiency or imbalance. Long-chain fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are essential to proper brain functioning and several studies involving children with ADHD have shown that they are deficient in these essential fatty acids. Researchers at the University of South Australia report that an EPA and DHA containing supplement is effective in reducing ADHD symptoms.
Their clinical trial involved 103 Australian children (74% boys) between the ages of 7 and 12 years. The children had all been diagnosed with ADHD and had scores two standard deviations or more above the general population on the Conners abbreviated ADHD Index. The trial participants were randomized to receive either placebo capsules (palm oil), fatty acid capsules (providing 560 mg/day of EPA, 175 mg/day of DHA, 60 mg/day of gamma-linolenic acid, and 10 mg/day of vitamin E), or fatty acid capsules + a multivitamin tablet containing low (RDA) amounts of vitamin and minerals.
After 15 weeks all children were given fatty acid capsules + daily multivitamin for a further 15 weeks. They were evaluated for ADHD symptoms after 15 and 30 weeks. At 15 weeks their scores on the Conners Parent Rating Scale were significantly reduced in regard to hyperactivity, inattention and impulsivity, and improvement was also noted in the sub-scores for perfectionism and social problems. There was no indication that adding the multivitamin to the fatty acid regimen had any additional benefits. Improvements continued until the end of the trial at week 30 at which time 40-50% of the treated children showed improvements corresponding to at least one standard deviation on the Conners ADHD Index. This improvement is equivalent to, or slightly better than, the improvement observed after 4 weeks of treatment with short-acting methylphenidate (Ritalin).
According to Canadian researchers who performed a meta-analysis of 62 randomized trials of Ritalin, there is no evidence that this drug is effective beyond 4 weeks and there is considerable evidence of its many adverse effects including decreased appetite, insomnia, headaches, stomach aches, drowsiness, anxiety, irritability, and dizziness.
Sinn, N. and Bryan, J. Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental & Behavioral Pediatrics, Vol. 28, April 2007, pp. 82-91
Schachter, HM, et al. How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? Canadian Medical Association Journal, Vol. 165, November 27, 2001, pp. 1475-88
Fish oils reduce ADHD symptoms
OXFORD, UNITED KINGDOM. Neurodevelopmental disorders are becoming increasingly common among school-age children. It is estimated that about 5% of British school children suffer from developmental coordination disorder (DCD), while 1-2% suffer from attention deficit/hyperactivity disorder syndrome (ADHD). In the United States the prevalence of ADHD is estimated at 4%. DCD is characterized by problems with motor function (manual dexterity, ball skills and balance) and difficulties in learning, behavioural problems, and lack of social skills. The main symptoms of ADHD are cognitive problems (problems with thinking, learning and remembering), hyperactivity, anxiousness, shyness, perfectionism, opposition, social problems, excessive talkativeness, restlessness and noisiness.
It is well established that the main components of fish oil, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), together with the omega-6 fatty acids, arachidonic acid (AA) and dihomogamma linolenic acid (DGLA), play a major role in the structure of neuronal membranes. There is also substantial evidence that children with ADHD tend to be deficient in EPA and DHA.
Considering this evidence, researchers at Oxford University decided to investigate whether supplementation with fish oils would help children with DCD and ADHD. Their clinical trial involved 100 children between the ages of 5 and 12 years who had been diagnosed with DCD and showed symptoms of ADHD as well. The children were randomized to receive 6 placebo (olive oil) capsules a day or 6 capsules a day of an essential fatty acid (EFA) mixture providing a total of 558 mg of EPA, 174 mg of DHA, 60 mg of gamma-linolenic acid plus 10 mg of natural alpha-tocopherol (vitamin E). Half the children received the EFA mixture for 6 months, while the other half received the placebo for 3 months and then the EFA mixture for the remaining 3 months of the trial.
The improvements in the EFA groups were substantial. While no improvement was noted in motor skills, both reading and spelling skills improved significantly. The mean increase in reading age for the first 3 months was 9.5 months in the EFA group versus 3.3 months in the placebo group. Similarly, the increase in spelling age during the first 3 months of the trial was 6.6 months in the EFA group versus 1.2 months in the placebo group. Improvements in ADHD symptoms were also substantial, particularly in regard to hyperactivity, cognitive problems, anxiousness and shyness. The rate of improvements noted for the first 3 months continued for the subsequent 3 months of the trial. The researchers conclude that the EFA supplement may be a safe, tolerable and effective treatment for improving academic progress and behaviour among children with DCD.
Richardson, A.J. and Montgomery, P. The Oxford-Durham study: a randomized, controlled trial of dietary supplementation with fatty acids in children with developmental coordination disorder. Pediatrics, Vol. 115, May 2005, pp. 1360-66
Attention-deficit disorder in adults
SUNBURY, OHIO. Attention-deficit hyperactivity disorder (ADHD) is characterized by hyperactivity,
emotional instability, poor coordination, short attention span, poor concentration, impulsiveness, and
learning disorders. It is very common among school-age children with an incidence of between four and
twenty per cent. Dr. Eugene Arnold, MD, Professor of Psychiatry at Ohio State University, points out that
ADHD is not just a childhood disorder, but can be found among adults as well. Dr. Arnold has just
completed an exhaustive survey of alternative treatments for adult ADHD. Although none of these
treatments have undergone strictly controlled clinical trials some of them may nevertheless be worth a try.
Relaxation training, biofeedback, meditation and massage are safe therapies that may have benefits.
Fish oil supplementation, vitamins and minerals (in RDA dosages), herbal and homeopathic remedies,
laser acupuncture, and anti-fungal (Candida) therapy may also be of benefit. Thyroid dysfunction and
chronic lead poisoning are possible causes of ADHD and should be investigated and treated if necessary.
Chelation is effective in removing lead. Zinc and magnesium supplementation may be useful if a
deficiency is present and St. John's wort (hypericum) should at least be given a pilot study according to
Dr. Arnold.
Arnold, L. Eugene. Alternative treatments for adults with ADHD. Annals of the New York Academy of
Sciences, Vol. 931, June 2001, pp. 310-41
Docosahexaenoic acid deficiency may be key to ADHD
WEST LAFAYETTE, INDIANA. It is estimated that 3-5% of the school-age population in the United
States suffer from attention-deficit hyperactivity disorder (ADHD). Prominent symptoms of this disorder
are a poor attention span, inability to complete tasks, hyperactivity, and a tendency to interrupt others.
Almost one quarter of children with ADHD also suffer from one or more specific learning disabilities in
math, spelling or reading.
A study first reported in 1995 linked ADHD to a deficiency of certain long-chain fatty acids. These acids
(arachidonic, eiscosapentaenoic, and docosahexaenoic acids) are all metabolites of the two essential
fatty acids, linoleic acid (omega-6) and alpha-linolenic acid (omega-3). Researchers at Purdue University
are now leaning towards the conclusion that a subclinical deficiency in docosahexaenoic acid (DHA) is
responsible for the abnormal behaviour of children with ADHD. They point out that supplementation with
a long-chain omega-6 fatty acid (evening primrose oil) has been unsuccessful in ameliorating ADHD and
believe this is because ADHD-children need more omega-3 acids rather than more omega-6 acids. The
researchers also found that children with ADHD were breast fed less often as infants than were children
without ADHD. Breast milk is an excellent source of DHA. A study is now underway to investigate the
effect of oral supplementation with DHA on the behaviour of ADHD-children.
Burgess, John R., et al. Long-chain polyunsaturated fatty acids in children with attention-deficit
hyperactivity disorder. American Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 327S-
30S
Fish oils may help dyslexic children
GUILDFORD, UNITED KINGDOM. Dyslexia is a fairly common condition which involves difficulties in
learning to read and write, mirror reversals of letters and words, and poor short-term memory. Dyslexia
is closely related to dyspraxia (problems with coordination and muscle control) and attention-deficit
hyperactivity disorder. It is estimated that about 10% of the populations of the United States and the
United Kingdom suffer from dyslexia and 4% are severely affected. There was a 3-fold increase in the
prevalence of learning disorders in the USA over the period 1976 to 1993 and 80% of the new cases
involved dyslexia.
Dr. Jacqueline Stordy of the University of Surrey believes that dyslexia, dyspraxia, and attention-deficit
hyperactivity disorder have one common denominator - a deficiency of long-chain fatty acids. She points
to a study which found improved dark adaptation (a problem among dyslexics) after supplementation with
480 mg/day of docosahexaenoic acid (a main constituent of fish oil) for a month. Another study involving
15 dyspractic children found that supplementation with a proprietary mixture of tuna oil, evening primrose
oil, thyme oil, and vitamin E for 4 months markedly improved their motor skills. The mixture provided 480
mg of docosahexaenoic acid, 35 mg of arachidonic acid, 96 mg of alpha-linolenic acid, 80 mg of vitamin
E, and 24 mg of thyme oil daily. Dr. Stordy concludes that long-chain polyunsaturated fatty acid
supplements may benefit children with dyslexia, dyspraxia, and attention-deficit hyperactivity disorder and
notes that large, double-blind, placebo-controlled studies are already underway to verify this hypothesis.
Stordy, B. Jacqueline. Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. American
Journal of Clinical Nutrition, Vol. 71 (suppl), January 2000, pp. 323S-26S
Your brain needs DHA
NEW YORK, NY. Dr. Barbara Levine, Professor of Nutrition in Medicine at Cornell University, sounds the
alarm concerning a totally inadequate intake of DHA (docosahexaenoic acid) by most Americans. DHA is
the building block of human brain tissue and is particularly abundant in the grey matter of the brain and
the retina. Low levels of DHA have recently been associated with depression, memory loss, dementia,
and visual problems. DHA is particularly important for fetuses and infants; the DHA content of the infant's
brain triples during the first three months of life. Optimal levels of DHA are therefore crucial for pregnant
and lactating mothers. Unfortunately, the average DHA content of breast milk in the United States is the
lowest in the world, most likely because Americans eat comparatively little fish. Making matters worse is
the fact that the United States is the only country in the world where infant formulas are not fortified with
DHA. This despite a 1995 recommendation by the World Health Organization that all baby formulas
should provide 40 mg of DHA per kilogram of infant body weight. Dr. Levine believes that postpartum
depression, attention deficit hyperactivity disorder (ADHD), and low IQs are all linked to the
dismally low DHA intake common in the United States. Dr. Levine also points out that low DHA levels
have been linked to low brain serotonin levels which again are connected to an increased tendency to
depression, suicide, and violence. DHA is abundant in marine phytoplankton and cold-water fish and
nutritionists now recommend that people consume two to three servings of fish every week to maintain
DHA levels. If this is not possible, Dr. Levine suggests supplementing with 100 mg/day of DHA.
Levine, Barbara S. Most frequently asked questions about DHA. Nutrition Today, Vol. 32,
November/December 1997, pp. 248-49
Hyperactive children lack essential fatty acids
WEST LAFAYETTE, INDIANA. Children suffering from attention-deficit hyperactivity disorder (ADHD) are
inattentive, impulsive, and hyperactive. Researchers at Purdue University now report that hyperactive
children have lower levels of key fatty acids in their blood than do normal children. Their experiment
involved 53 boys aged 6 to 12 years of age who suffered from ADHD, but were otherwise healthy and 43
matched controls. Analyses showed that the boys with ADHD had significantly lower levels of
arachidonic, eicosapentaenoic, and docosahexaenoic acids in their blood. The hyperactive children
suffered more from symptoms associated with essential fatty acid deficiency (thirst, frequent urination,
and dry hair and skin) and were also much more likely to have asthma and to have had many ear
infections. The researchers conclude that ADHD may be linked to a low intake of omega-3 fatty acids
(linolenic, eicosapentaenoic, and docosahexaenoic acids) or a poorer ability to convert 18-carbon fatty
acids to longer more highly unsaturated acids. The researchers conclude that supplementation with the
missing fatty acids may be a useful treatment for hyperactivity.
Stevens, Laura J., et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity
disorder. American Journal of Clinical Nutrition, Vol. 62, No. 4, October 1995, pp. 761-68
ADHD and essential fatty acids
AUCKLAND, NEW ZEALAND. Researchers at the School of Medicine at the University of Auckland
released a fascinating report which throws a great deal of light on the question "Why are hyperactive
children different from normal children"?
The study involved 48 hyperactive children and 49 age- and sex-matched controls. The hyperactive
children were selected based on input from both teachers and parents and all participants were evaluated
using four behaviour rating scales. The researchers discovered numerous, statistically significant
differences between hyperactive and normally behaved children:
- Hyperactive children had significantly lower birth weights and learned to walk later than normal
children;
- Hyperactive children were more likely to have frequent coughs and colds (44% vs. 8% among normal
children);
- 52% of hyperactive children had an abnormal degree of thirst compared to only 6% in the control
group;
- Hyperactive children were more likely to have speech and language difficulties (32% vs. 6%) and
difficulties in learning (67% vs. 6%).
Blood analyses showed that hyperactive children had significantly depressed levels of docosahexaenoic,
dihomogammalinolenic, and arachidonic acids. Other research has found that hyperactive children also
tend to have lower zinc levels. The researchers point out that male animals require 3 times as much
EFAs (essential fatty acids) as do females in order to achieve normal neonatal and infant development;
this is consistent with the finding that hyperactivity is far more common among boys than among girls.
They also report that they carried out a double-blind, placebo-controlled, crossover study of
supplementation with evening primrose oil in 31 selected hyperactive children. No benefits of the
supplementation were observed. NOTE: This study was partially funded by Efamol Research Ltd., a
manufacturer of evening primrose oil supplements.
Mitchell, E.A., et al. Clinical characteristics and serum essential fatty acid levels in hyperactive children.
Clinical Pediatrics, Vol. 26, August 1987, pp. 406-11
